Abnormal menstrual bleeding
Table of contents
Extract
- A detailed history of menstrual bleeding is often more important than the pelvic examination.
- Classification of the causes of abnormal menstrual bleeding according to FIGO's (International
Federation of Gynecology and Obstetrics) PALM-COEIN mnemonic
- Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
Linked evidence summaries
- Tranexamic acid may be effective and may be more effective than desmopressin for heavy menstrual bleeding in women with bleeding disorders.C↑↑
- Desmopressin might possibly be effective for heavy menstrual bleeding compared to placebo in women with bleeding disorders. Tranexamic acid may be more effective than desmopressin.D
- Levonorgestrel-releasing intrauterine device (LNG IUS) is effective for heavy menstrual bleeding reducing menstrual blood loss by 80-95 percentage. LNG IUS is more effective than drug therapy, and appears to be as effective as endometrial ablation.A↑↑
- Both hysterectomy and endometrial resection and ablation are effective treatments for heavy menstrual bleeding, but hysterectomy may be superior for permanency of the result.A↑↑
- Progestogen-releasing intrauterine system (LNG-IUS) may reduce menstrual blood loss in premenopausal women with uterine fibroids.C↑
- Uterine artery embolization (UAE) and myomectomy are effective for symptomatic uterine fibroids. However, uterine artery embolization has higher reintervention rates.A
- Tranexamic acid is effective in heavy menstrual bleeding reducing blood loss up to 50 per cent compared with placebo and appears to be more effective than other medical therapies (NSAIDs, progestagens, and ethamsylate) but less effective than levonorgestrel intrauterine system.A↑↑
- NSAIDs are effective for heavy menstrual bleeding compared with placebo but are less effective than either tranexamic acid, danazol, or the levonorgestrel releasing intrauterine system.A↑↑
- Combined oral contraceptives are effective for heavy menstrual bleeding compared with placebo.A↑↑
- Surgery, especially hysterectomy, is more effective than medical treatment in reducing heavy menstrual bleeding at one year. Surgery and levonorgestrel-releasing intrauterine device are both effective in improving quality of life.A↑↑
- In benign gynaecological diseases, operative time and return to normal daily activities is shorter after vaginal hysterectomy compared to abdominal hysterectomy or laparoscopic hysterectomy. The risk of pelvic organ prolapse may be greater in vaginal hysterectomy compared with abdominal of lapraroscopic route.B
Search terms
Adenomyoma, Amenorrhea, Contraceptives, Oral, Combined, Corpus Luteum Hormones, Curettage, Diclofenac, Endocrinology, Estrogens, Gynaecological bleeding, Gynaecological haemorrhage , Gynaecology, Ibuprofen, Intrauterine Devices, Mefenamic Acid, Menarche, Menorrhagia, Menstrual Cycle, Menstruation Disturbances, Metrorrhagia, N92, N92.0, N92.1, N92.2, N92.3, N92.4, N92.5, N92.6, N93, N93.8, N93.9, Naproxen, Norethindrone, Oligomenorrhea, Ovulation, Progestins, Tranexamic Acid, Uterus, anovulatory bleeding, corpus luteum insufficiency, dysfunctional uterine bleeding, endometrial ablation, hormone-releasing IUD, lynestrenol, menorrhagia, norethindrone acetate, ovulation bleeding, ovulatory bleeding disorder, polymenorrhea, progestins, cyclic, spotting, von Willebrand Disease