Diagnosis and medical management of abnormal premenopausal and postmenopausal bleeding

Abstract

Abnormal uterine bleeding is a common reason for presentation to health-care providers: it is estimated that one woman in three will present to a care provider with abnormal uterine bleeding (AUB) during the reproductive years, and that at least one woman in 10 will experience postmenopausal bleeding. Although there are some variations in national guidelines for investigation, diagnosis and management of premenopausal AUB, there are far more areas of agreement than disagreement. A comprehensive literature search was undertaken to review national and international guidelines regarding investigation, diagnosis and management of AUB in both premenopausal and postmenopausal women. Areas of controversy are identified, and latest evidence reviewed. Although efforts to reduce hysterectomies for premenopausal AUB through medical management have largely been successful, there are areas where more research is necessary to guide optimal investigation and management. Many countries have well-defined guidelines for investigation and management of premenopausal AUB: there are fewer well-developed guidelines for investigation and management of postmenopausal bleeding. There is a paucity of evidence-based data on management of unscheduled bleeding on menopausal hormone therapy.

摘要

异常子宫出血是医务工作者被主诉的常见病因：据估计, 三分之一的女性将在育龄期向医务工作者主诉异常子宫出血(AUB), 并且至少十分之一的女性将经历绝经后出血。尽管各国对绝经前AUB的调研、诊断和治疗管理指南存在一些差异, 但一致的方面远远多于分歧。对国内外有关绝经前和绝经后女性AUB的调研、诊断和治疗管理指南进行了全面的文献检索。确定有争议的方面, 并审查最新的证据。虽然通过药物治疗减少绝经前AUB子宫切除术在很大程度上是有效的, 但仍需进行更多的研究从而优化调研和治疗。许多国家都有明确的绝经前AUB的调研和治疗管理指南：很少有完善的绝经后出血的调研和治疗管理指南。关于绝经期激素治疗非预期子宫出血的管理缺乏循证医学证据。

Keywords:

• Premenopausal abnormal uterine bleeding
• postmenopausal bleeding
• heavy menstrual bleeding
• menopausal hormone therapy

Potential conflict of interest

D. Black has received consulting/speaker fees from AbbVie, Amgen, Bayer, Biosyent, Duchesnay, Organon, Merck and Pfizer Searchlight.

Source of funding

Nil.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.