- ACRONYMS AND DEFINITIONS
- ACOG - American College of Obstetricians and Gynecologists
- Cyclical bleeding - menstrual bleeding that occurs at a predictable time interval
- Menorrhagia - bleeding exceeding 8 days’ duration or heavy enough to interfere with a woman’s quality of life
- Metrorrhagia - bleeding at irregular intervals, particularly between expected menstrual periods
- Noncyclical bleeding - menstrual bleeding that occurs at an unpredictable or irregular interval
- Oligomenorrhea - infrequent menstrual periods
- Polymenorrhea - menstrual cycles that are shorter than 21 days
- PREVALENCE
- Abnormal uterine bleeding affects approximately one-third of women throughout their lifetime. Abnormal uterine bleeding may refer to heavy menstrual bleeding, bleeding at irregular intervals, or a combination of the two. [3]
- CAUSES AND SYMPTOMS
- Overview
- The tables below list some causes of heavy cyclical bleeding and noncyclical bleeding
- Bleeding patterns can provide clues to the underlying pathology, but they are not specific, and in many cases, different patterns may coexist
Heavy Cyclical Bleeding | |
---|---|
Cause | Comments |
Adenomyosis |
|
Anticoagulant use |
|
Coagulation disorders |
|
Copper IUD |
|
Leiomyoma (fibroids) |
|
Noncyclical Bleeding | |
---|---|
Cause | Comments |
Cervical polyp |
|
Cervicitis |
|
Endometrial hyperplasia |
|
Endometrial polyp |
|
Endometritis |
|
Hormonal contraceptives |
|
Hyperprolactinemia |
|
Kidney disease |
|
Malignancy (endometrial, cervical, vaginal) |
|
Menarche |
|
Perimenopause |
|
Polycystic ovary syndrome |
|
Thyroid disease |
|
- MENORRHAGIA WORKUP
ACOG recommendations for working up menorrhagia |
---|
All patients
|
Most patients
|
Patients at risk for coagulopathy (see coagulopathy screening below)
|
Women ≥ 45 years old
|
Other considerations in appropriate patients
|
- COAGULOPATHY SCREENING
ACOG recommendations for coagulopathy screening in menorrhagia |
---|
Screen patients for coagulopathy if they meet any 1 of the following 3 criteria: |
1. Heavy menstrual bleeding since menarche |
2. One of the following:
|
3. Two or more of the following:
|
Initial lab testing
|
- TREATMENT
ACOG recommendations for acute treatment of uncontrolled bleeding |
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Conjugated estrogens injection (Premarin®)
|
Monophasic OCP with 35 mcg of ethinyl estradiol
|
Medroxyprogesterone (Provera®)
|
Tranexamic acid (Lysteda®)
|
- Chronic treatment
- Oral contraceptives
- Medroxyprogesterone shot
- Mirena® IUD
- Tranexamic acid (Lysteda®)
- Dosed as two 650 mg tablets (1300 mg) three times a day for 5 days during monthly menstruation
- See Lysteda® PI for more
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Oriahnn®
- Combination of estradiol/norethindrone acetate and elagolix which is a GnRH receptor antagonist
- Approved for use up to 24 months
- See Oriahnn® PI for more
- Myfembree®
- Combination of estradiol/norethindrone acetate and relugolix which is a GnRH receptor antagonist
- Approved for use up to 24 months
- See Myfembree® PI for more
- Endometrial ablation
- Uterine artery embolization for fibroids
- Hysterectomy
- BIBLIOGRAPHY
- 1 - PMID 26254516 - ACOG GL
- 2 - PMID 2034248 - NEJM review
- 3 - PMID 31070673 - Abnormal Uterine Bleeding in Reproductive-AgeWomen, JAMA (2019)