Blagoveshchensky R. E.

LITERATURE REVIEWS

Scentific article

Abnormal uterine bleeding (AUB) is an urgent clinical problem that has not been fully studied at this stage. AUB affects the quality of life, causes reproductive losses, and requires significant health care costs. The purpose of the study is to outline and generalize the basic principles of diagnosis and presentation of AUB in women of reproductive age based on literature analysis and international recommendations. A literature review of world citation databases (MEDLINE, EMBASE, Cochrane) over the last 10 years was conducted. The concept of a normal menstrual cycle and AUB is defined. The classification of the International Federation of Gynecology and Obstetrics is presented. The main pathological conditions resulting in AUB have been determined. To choose a rational strategy for patient management, it is necessary to establish the cause of AUB and assign it to one of the categories according to the PALM-COEIN classification. PALM-COEIN classification distinguishes two main groups of AUB, related and not related to organic disorders of the uterus. A morphologic cause (PALM) can be diagnosed by imaging and/or histology, while the COEIN group is associated with causes that cannot be visualized (non-morphologic). According to international recommendations, laboratory diagnosis of patients with AUB involves certain stages: determination of the level of β-HCG in blood serum; examination for the presence of anemia; determination of the coagulogram. Hormonal examination is carried out in case of irregular menstrual rhythm and risk of hypothyroidism; tests on chlamydial infection (in case of high infection risk); a Pap test is performed to rule out cervical diseases. Hysteroscopy and endometrial biopsy are considered the “gold standard” for the diagnosis of intrauterine abnormalities, primarily to exclude precancerous lesions and endometrial cancer

abnormal uterine bleeding,menstrual cycle,morphological and non-morphological causes,intrauterine abnormalities

1. Benetti-Pinto CL, Rosa-E-Silva ACJS, Yela DA, Soares Júnior JM. Abnormal Uterine Bleeding. Rev Bras Ginecol Obstet. 2017;39(7):358- 368. DOI: 10.1055/s-0037–1603807.
2. Singh S, Best C, Dunn S, Leyland N, Wolfman WL. No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018;40(5):e391-e413. DOI: 10.1016/j.jogc.2018.03.007.
3. Khrouf M, Terras K. Diagnosis and Management of Formerly Called ‘‘Dysfunctional Uterine Bleeding’’ According to PALM-COEIN FIGO Classification and the New Guidelines. J Obstet Gynecol India. 2014;64(6):388- 393. DOI: 10.1007/s13224–014–0641–1.
4. Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143:393-408. DOI: 10.1002/ijgo.12666.
5. Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynecol Obstet. 2015;128(3):196-200. DOI: 10.1016/j.ijgo.2014.09.027.
6. Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019;220(6):569e1-e7. DOI: 10.1016/j.ajog. 2019.02.048.
7. National Guideline Alliance (UK). Heavy menstrual bleeding (update) Guideline, No. 88 [Internet]. London: National Institute for Health and Care Excellence; 2018. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK493300/
8. Bull JR, Rowland SP, Scherwitzl EB, Scherwitzl R, Danielsson KG, Harper J. Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. NPJ Digit Med. 2019;2:83. DOI: 10.1038/s41746-019-0152-7.
9. Davis E, Sparzak PB. Abnormal Uterine Bleeding [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www. ncbi.nlm. nih.gov/books/NBK532913/.
10. Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol. 2017;40:3-22. DOI: 10.1016/j.bpobgyn.2016.09.011.
11. Bulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344-55. DOI: 10.1056/NEJMra1209993.
12. Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157-178. DOI: 10.1016/S1701-2163(15)30338-8.
13. Royal College of Obstetricians and Gynaecologists. Management of endometrial hyperplasia [Internet]. British Society for Gynaecological Endoscopy green-top guideline, 67. 2016. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf.
14. Sobczuk K, Sobczuk A. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Prz Menopauzalny. 2017;16(3):107-111. DOI: 10.5114/pm.2017.70589.
15. Lewin SN. Revised FIGO staging system for endometrial cancer. Clin Obstet Gynecol. 2011;54(2):215-8. DOI: 10.1097/ GRF.0b013e3182185baa.
16. Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The revised FIGO staging system for uterine malignancies: implications for MR imaging. Radiographics. 2012;32(6):1805-27. DOI: 10.1148/rg.326125519.
17. Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2006 Apr 19;2:CD003855. DOI: 10.1002/14651858.CD003855.pub2.
18. Dickerson KE, Menon NM, Zia A. Abnormal Uterine Bleeding in Young Women with Blood Disorders. Pediatr Clin North Am. 2018;65(3):543- 560. DOI: 10.1016/j.pcl.2018.02.008.
19. De Crem N, Peerlinck K, Vanassche T, Vanheule K, Debaveye B, Middeldorp S, et al. Abnormal uterine bleeding in VTE patients treated with rivaroxaban compared to vitamin K antagonists. Thromb Res. 2015;136(4):749-53. DOI: 10.1016/j.thromres.2015.07.030.
20. Bryk AH, Pirog M, Plens K, Undas A. Heavy menstrual bleeding inwomen treated with rivaroxaban and vitamin K antagonists and the risk ofrecurrent venous thromboembolism. Vascul Pharmacol. 2016;87:242-247. DOI: 10.1016/j.vph.2016.11.003.
21. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013;122(1):176- 185. DOI: 10.1097/01.AOG.0000431815.52679.bb.
22. NICE. Heavy menstrual bleeding: assessment and management. London: National Institute for Health and Care Excellence (NICE); 2021 May 24. Available from: https://www.nice.org.uk/guidance/ng88.
23. Yoon DJ, Jones M, Taani JA, Buhimschi C, Dowell JD. A systematic review of acquired uterine arteriovenous malformations: Pathophysiology, diagnosis, and transcatheter treatment. AJP Rep. 2016;6:e6-e14. DOI: 10.1055/s-0035-1563721.
24. Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 2016;23:893- 902. DOI: 10.1016/j.jmig.2016.06.020.
25. Tuchkina IA, Gnatenko OV, Tuchkina MYu. Diagnosis and treatment of adolescents and young women with abnormal uterine bleeding and retention ovarian cysts in the presence of extragenital pathology. Collection of scientific works of the Association of Obstetricians and Gynecologists of Ukraine. 2018;2(42):191-197.
26. Tatarchuk TF, Cossey NV, Redko NA, Dzhupin VA. Diagnostika i lecheniye anomalʹnykh matochnykh krovotecheniy. Reproduktivnaya endokrinologiya. 2014;5(19):22-32. DOI: 10.18370/2309-4117.2014.19.22-32.
27. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891-896. DOI: 10.1097/01.AOG.0000428646.67925.9a.
28. Hauk L, American College of Obstetricians and Gynecologists. ACOG releases guidelines on management of abnormal uterine bleeding associated with ovulatory dysfunction. Am Fam Physician. 2014;89(12):987-8.

«Bulletin of problems biology and medicine» Issue 3 (166), 2022 year, 12-17 pages, index UDK 618.14-005.1-036.1-048.445

10.29254/2077-4214-2022-3-166-12-17