DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204280

A study of causes, investigation and management of structural causes of abnormal uterine bleeding in reproductive age group

Vibhusha S. Rohidas, Niranjan N. Chavan

Abstract


Background: Abnormal uterine bleeding (AUB) is debilitating condition affecting 14-25% of women of reproductive age. It has significant impact on women’s personal, social, physical and quality of life. Present study is planned to study causes, investigation along with management of structural causes of abnormal uterine bleeding in reproductive age group.

Methods: Consecutive type of non-probability sampling was used for selection of study subjects. A total of 100 gynaecology OPD women diagnosed with menorrhagia of 15-45 years age group were enrolled in study.

Results: Mean age of the study subjects was between 26-35 years (47%). 67% were from low socio-economic class while 33% were from middle class. Maximum number of women (66%) had symptoms for less than 6 months. 47% presented with Menorrhagia. 89% were Multiparous, and 11% were Nulliparous. Most common structural causes of AUB was leiomyoma (41%) followed by polyps (23%), adenomyosis (17%), endometrial hyperplasia (15%) and endometrial carcinoma (4%). Prevalence of anemia was 73% in present study. Maximum leiomyoma were treated medically while higher percentage of polyps and hyperplasia was treated surgically. Most commonly performed surgery was polypectomy (20%) followed by dilatation and curettage (17%) and myomectomy (15%). Total abdominal hysterectomy was done in 8% cases while radical hysterectomy was done in 2% cases.

Conclusions: Benign lesions of endometrium account for majority of cases presenting with AUB in reproductive age group. Other premalignant and malignant causes should also be considered. High prevalence of anemia was observed in these cases. A comparative clinicopathological study will help in arriving at the cause and correct diagnosis. Histopathological examination is one of the major tools in evaluation of abnormal uterine bleeding and helps us in proper management and treatment of cases.

 


Keywords


Abnormal uterine bleeding, Anaemia, Endometrial hyperplasia, Leiomyoma, Menorrhagia, Polyps, Reproductive age group

Full Text:

PDF

References


Fraser IS, Langham S, Uhl-Hochgraeber K. Health related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol. 2009;4:179-89.

NICE. Clinical Guideline 44; Heavy menstrual bleeding. 2007. National Institute for Health and Clinical Excellence (NICE); Available at: https://www.nice.org.uk/guidance/ng88/evidence/full-guideline-pdf-4782291810.

Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders System. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13.

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.

Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. Fertil Steril. 2008;90(6):2269-80.

Davidson BR, DiPiero CM, Govoni KD, Littleton SS, Neal JL. Abnormal uterine bleeding during the reproductive years. J Midwife Womens Health. 2012;57(3):248-54.

Saidi MH, Sadler RK, Theis VD, Akright BD, Farhart SA, Villanueva GR. Comparison of sonography, sonohysterography, and hysteroscopy for evaluation of abnormal uterine bleeding. J Ultrasound Med. 1997;16(9):587-91.

Venugopalan SK, Pandian NS, Pavani M, Rao TS, Rajini Y, Khadeer SK. abnormal uterine bleeding in reproductive women: Diagnosis, management and treatment. Asian J Pharm Clin Res. 2015;8:42-5.

Sudha R, Pallavi YR. Distribution of causes of abnormal uterine bleeding according to polyp adenomyosis leiomyoma malignancy and hyperplasia coagulopathy ovulatory dysfunction endometrial latrogenic not yet classified classification in a tertiary care center. Int J Scient Stud. 2017;4(10):159-62.

Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study. Medicine. 2018;97(31):e11457.

Panda A, Parulekar SV, Gupta A. diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. J Obst Gynecol India 1999;175:74-6

Goyal BK, Gaur I, Sharma S, Saha A, Das NK. Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding. Med J Armed Forces India. 2015;71(2):120-5.

Chhikara A, Bharti A. Role of hysteroscopy in the evaluation of abnormal uterine bleeding. Indian J Appl Res. 2016;6(6).

Geeta G, Sandhu SK, Lele A, Khare S. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynecol India. 2011;61(5):546-9.

Sunitha CH. A clinical study of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. IOSR J Dent Med Sci. 2013;5(3):43-46.

Mishra D, Sultan S. FIGO’s PALM-COEIN classification of abnormal uterine bleeding: a clinico-histopathological correlation in Indian Setting. J Obstet Gynecol India. 2017;67(2):119-25.

Betha K, Malavatu L, Talasani S. Distribution of causes of abnormal uterine bleeding using new FIGO classification system-PALM COEIN: a rural tertiary hospital based study. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3523-7.

Wamsteker K. Hysteroscopy in the management of abnormal uterine bleeding in 199 patients. In: Siegler AM, Lindemann HJ, editors. Hysteroscopy: Principles and Practice. Philadelphia: JB Lippincott; 1984:128-131.

VanTrotsenburg M, Wieser F, Naegle F. Diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal patients. Contrib Gynecol Obstet 2000;20:21-6.

deWit AC, Vleugels MP, deKruif JH. Diagnostic hysteroscopy: A valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma? Six years of experience with non clinical diagnostic hysteroscopy. Eur J Obstet Gynecol Reprod Biol. 2003;110:79-82.

Matteson KA, Raker CA, Pinto SB, Scott DM, Frishman GN. Women presenting to an emergency facility with abnormal uterine bleeding: patient characteristics and prevalence of anaemia. J Reprod Med. 2012;57:17.