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Abnormal Vaginal Bleeding During the Early Reproductive Years

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Handbook of Gynecology

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Abstract

New terminology was introduced by the Menstrual Disorder Working Group of the International Federation of Gynecology and Obstetrics (FIGO) and approved by ACOG several years ago to facilitate accurate descriptions of all dimension of each woman’s bleeding. These descriptors better characterize abnormal uterine bleeding patterns than the older imprecise terms, such as “dysfunctional uterine bleeding” and “menorrhagia”. The new PALM-COEIN classification system was implemented shortly thereafter to standardize reporting of etiologies of abnormal bleeding. Utilizing these new tools and current practice guidelines, this chapter will provide an overview of the differential diagnoses, evaluations, and treatment of women presenting with abnormal uterine bleeding from adolescence through the end of a woman’s reproductive years.

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References

  • American College of Obstetricians and Gynecologists. ACOG Committee on Practice Bulletin – Gynecology ACOG Committee on Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–6.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol. 2014;124(1):193–7.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists, ACOG Committee on Practice Bulletins – Gynecology. ACOG practice bulletin no. 108: polycystic ovary syndrome. Obstet Gynecol. 2009;114(4):936–49.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists, ACOG Committee on Adolescent Health Care, Committee on Gynecologic Practice. Committee opinion no.580: von Willebrand disease in women. Obstet Gynecol. 2013;122(6):1368–73.

    Article  Google Scholar 

  • American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2008;90(5 Suppl):S219–25.

    Google Scholar 

  • Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013;208(6):499. e1–5.

    Article  PubMed  Google Scholar 

  • Angioni S, Pontis A, Nappi L, Sedda F, Sorrentino F, Litta P, Haimovich S, Melis GB. Endometrial ablation: first- vs. second-generation techniques. Minerva Ginecol. 2016;68(2):143–53.

    PubMed  Google Scholar 

  • Bitzer J, Heikinheimo O, Nelson AL, Calaf-Alsina J, Fraser IS. Medical management of heavy menstrual bleeding: a comprehensive review of the literature. Obstet Gynecol Surv. 2015;70(2):115–30.

    Article  PubMed  Google Scholar 

  • Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016;214(1):31–44.

    Article  PubMed  Google Scholar 

  • Corona LE, Swenson CW, Sheetz KH, Shelby G, Berger MB, Pearlman MD, Campbell Jr DA, DeLancey JO, Morgan DM. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol. 2015;212(3):304. e1–7

    Article  PubMed  Google Scholar 

  • Coutinho EM, Segal SJ. Is menstruation obsolete? New York: Oxford University Press; 1999 . p. 190.xvi

    Google Scholar 

  • Cox L, Liu JH. Primary ovarian insufficiency: an update. Int J Womens Health. 2014;6:235–43.

    PubMed Central  Google Scholar 

  • de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, Hehenkamp WJ. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 10-years’ outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;193(5):1618–29.

    Google Scholar 

  • De Pergola G, Tartagni M, d'Angelo F, Centoducati C, Guida P, Giorgino R. Abdominal fat accumulation, and not insulin resistance, is associated to oligomenorrhea in non-hyperandrogenic overweight/obese women. J Endocrinol Investig. 2009;32(2):98–101.

    Article  CAS  Google Scholar 

  • DeVore GR, Owens O, Kase N. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding – a double-blind randomized control study. Obstet Gynecol. 1982;59(3):285–91.

    CAS  PubMed  Google Scholar 

  • Donnez J, Vázquez F, Tomaszewski J, Nouri K, Bouchard P, Fauser BC, Barlow DH, Palacios S, Donnez O, Bestel E, Osterloh I, Loumaye E, PEARL III and PEARL III Extension Study Group. Long-term treatment of uterine fibroids with ulipristal acetate ☆. Fertil Steril. 2014;101(6):1565–73. e1–18

    Article  CAS  Google Scholar 

  • Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev 2014; (7):CD004695.pub3.

    Google Scholar 

  • Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383–90.

    Article  PubMed  Google Scholar 

  • Freeman EW, Lukes A, VanDrie D, Mabey RG, Gersten J, Adomako TL. A dose-response study of a novel, oral tranexamic formulation for heavy menstrual bleeding. Am J Obstet Gynecol. 2011;205(4):319. e1–7

    Article  PubMed  Google Scholar 

  • Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.

    Google Scholar 

  • Gallos ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(6):547. e1–10.

    Article  PubMed  Google Scholar 

  • Gupta JK, Daniels JP, Middleton LJ, Pattison HM, Prileszky G, Roberts TE, Sanghera S, Barton P, Gray R, Kai J, ECLIPSE Collaborative Group. A randomized controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia: the ECLIPSE trial. Health Technol Assess. 2015;19(88) i-xxv:1–118.

    Article  Google Scholar 

  • Hallberg L, Högdahl AM, Nilsson L, Rybo G. Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand. 1966;45(3):320–51.

    Article  CAS  PubMed  Google Scholar 

  • Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91(1):46–52.

    PubMed  Google Scholar 

  • Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc. 2013;88(9):996–1009.

    Article  Google Scholar 

  • Jovanovic VP, Carmina E, Lobo RA. Not all women diagnosed with PCOS share the same cardiovascular risk profiles. Fertil Steril. 2010;94(3):826–32.

    Article  PubMed  Google Scholar 

  • Kashefi F, Khajehei M, Alavinia M, Golmakani E, Asili J. Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: a placebo-controlled, randomized clinical trial. Phytother Res. 2015;29(1):114–9.

    Article  PubMed  Google Scholar 

  • Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, Muysers C, Jensen JT. Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(3):625–32.

    Article  CAS  PubMed  Google Scholar 

  • Kiseli M, Kayikcioglu F, Evliyaoglu O, Haberal A. Comparison of therapeutic efficacies of norethisterone, tranexamic acid and levonorgestrel-releasing intrauterine system for the treatment of heavy menstrual bleeding: a randomized controlled study. Gynecol Obstet Investig. 2016;81(5):447–53.

    Article  CAS  Google Scholar 

  • Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician. 2013;87(11):781–8.

    PubMed  Google Scholar 

  • Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol. 2013;209(3):202. e1–7

    Article  PubMed  Google Scholar 

  • Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK, Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013;(1):CD000400–pub3.

    Google Scholar 

  • Lethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015;(4):CD002126. pub3

    Google Scholar 

  • Livshits A, Seidman DS. Fertility issues in women with diabetes. Womens Health (Lond). 2009;5(6):701–7.

    Article  Google Scholar 

  • Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6–15.

    Article  PubMed  Google Scholar 

  • Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2016;(1):CD003855. pub3

    Google Scholar 

  • Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Investig. 2014;37(11):1049–56.

    Article  CAS  Google Scholar 

  • Munro MG, Critchley HO, Fraser IS; FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011;95(7):2204–2208, 2208.e1–3.

    Google Scholar 

  • Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108(4):924–9.

    Article  CAS  PubMed  Google Scholar 

  • Nelson AL, Ritchie JJ. Severe anemia from heavy menstrual bleeding requires heightened attention. Am J Obstet Gynecol. 2015;213(1):97. e1–6

    Article  PubMed  Google Scholar 

  • Nelson AL, Papa RR, Ritchie JJ. Asymptomatic cervical polyps: can we just let them be? Womens Health (Lond). 2015;11(2):121–6.

    Article  CAS  PubMed  Google Scholar 

  • Nelson AL, Vasquez L, Tabatabai R, Im SS The yield of endometrial aspiration I women with various risk factors and bleeding abnormalities. Contracept Reprod Med. 2016;1:9

    Google Scholar 

  • Philipp CS, Faiz A, Dowling N, Dilley A, Michaels LA, Ayers C, Miller CH, Bachmann G, Evatt B, Saidi P. Age and the prevalence of bleeding disorders in women with menorrhagia. Obstet Gynecol. 2005;105(1):61–6.

    Article  PubMed  Google Scholar 

  • Philipp CS, Faiz A, Heit JA, Kouides PA, Lukes A, Stein SF, Byams V, Miller CH, Kulkarni R. Evaluation of a screening tool for bleeding disorders in a US multisite cohort of women with menorrhagia. Am J Obstet Gynecol. 2011;204(3):209. e1–7

    Article  PubMed  PubMed Central  Google Scholar 

  • Rotteram ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.

    Article  Google Scholar 

  • Shaaban OM, Ali MK, Sabra AM, Abd El Aal DE. Levonorgestrel-releasing intrauterine system versus a low-dose combined oral contraceptive for treatment of adenomyotic uteri: a randomized clinical trial. Contraception. 2015;92(4):301–7.

    Article  CAS  PubMed  Google Scholar 

  • Tarney CM, Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;2014:192087.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tosi F, Fiers T, Kaufman JM, Dall’Alda M, Moretta R, Giagulli VA, Bonora E, Moghetti P. Implications of androgen assay accuracy in the phenotyping of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2016;101(2):610–8.

    Article  CAS  PubMed  Google Scholar 

  • Vilos GA, Tureanu V, Garcia M, Abu-Rafea B. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invasive Gynecol. 2009;16(4):480–4.

    Article  PubMed  Google Scholar 

  • Wasiak R, Filonenko A, Vanness DJ, Law A, Jeddi M, Wittrup-Jensen KU, Stull DE, Siak S, Jensen JT. Impact of estradiol valerate/dienogest on work productivity and activities of daily living in women with heavy menstrual bleeding. J Women’s Health (Larchmt). 2013;22(4):378–84.

    Article  Google Scholar 

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Authors and Affiliations

  1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Anita L. Nelson

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  1. Anita L. Nelson
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Correspondence to Anita L. Nelson .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

    Donna Shoupe

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Nelson, A.L. (2017). Abnormal Vaginal Bleeding During the Early Reproductive Years. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17798-4_23

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  • DOI: https://doi.org/10.1007/978-3-319-17798-4_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17797-7

  • Online ISBN: 978-3-319-17798-4

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