Tsypurdeeva A.A. Optimizing treatment approaches for patients with abnormal uterine bleeding

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Abstract

Abnormal uterine bleeding (AUB) is one of the most common symptoms in gynecological practice. AUB is nearly always a condition that reduces the quality of life and requires medical care.

Objective: To highlight modern approaches to the diagnosis and treatment of AUB, to develop an algorithm for the management of patients from various groups.

Materials and methods: The databases and information resources, namely eLibrary and PubMed, have been searched for publications, systematic reviews and meta-analyses using the words “abnormal uterine bleeding” and “profuse menstrual bleeding” for the period 2017–2023.

Results: Approaches to diagnosis and treatment directly depend on the nature of AUB, the cause of bleeding and its effect on hemodynamics. In case of acute AUB, the main task is to stop bleeding and stabilize the patient’s condition. In chronic bleeding, surgery is performed in addition to medical treatment. According to the Cochrane review and network meta-analysis, levonorgestrel-releasing IUD, antifibrinolytics, and progestogens in prolonged cyclic mode can be used as first-line therapy that effectively reduces blood loss. When prescribing hormonal therapy, it is recommended to explain the importance of following the instructions and consistency of taking the medications during the entire period of treatment. The effectiveness of progestogen therapy, which can contribute to the restoration of the physiological menstrual cycle, is of particular interest. Among the progestogens, dydrogesterone takes a special place as it is possible to personalize the treatment of patients due to high selectivity and good safety profile of dydrogesterone.

Conclusion: Progestogens remain some of the main medications for the treatment and prevention of AUB. When consulting patients, it is necessary to clarify their reproductive plans or the need for contraception as this information can help to personalize treatment. In prolonged cyclic mode, dydrogesterone can help normalize the menstrual cycle, including in patients planning pregnancy.

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About the authors

Arseny S. Molotkov

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine; St. Petersburg State University

Author for correspondence.
Email: arseny.molotkov@gmail.com

Associate Professor, PhD, Senior Researcher at the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology, Associate Professor performing medical work, Departments of Obstetrics, Gynecology and Reproductology, St. Petersburg State University

Russian Federation, 199034, St. Petersburg, Mendeleevskaya line, 3; 199034, St. Petersburg, Universitetskaya nab., 7/9

Maria I. Yarmolinskaya

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine; I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

Email: m.yarmolinskaya@gmail.com

Professor of RAS, Dr. Med. Sci., Head of the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, Professor, Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

Russian Federation, 199034, St. Petersburg, Mendeleyevskaya liniya, 3; 191015, St. Petersburg, Kirochnaya str., 41

Anna A. Tsypurdeeva

D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine; St. Petersburg State University
St. Petersburg

Email: tsypurdeeva@mail.ru
ORCID iD: 0000-0002-0304-4901

Associate Professor, Ph.D., Senior Researcher at the Department of Gynecology and Endocrinology and Head of Gynecology Department I with an operating unit, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, Associate Professor performing medical work, Departments of Obstetrics, Gynecology and Reproductology, St. Petersburg State University

Russian Federation, 199034, St. Petersburg, Mendeleevskaya line, 3; 199034, St. Petersburg, Universitetskaya nab., 7/9

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Application. Questionnaire-scheme for visiting patients with AUB
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3. Fig. 1. Algorithm for the management of a patient with AUB in the reproductive period at the inpatient stage

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4. Fig. 2. Algorithm for the management of a patient with AUB in the late reproductive period at the inpatient stage

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5. Fig. 3. Algorithm for managing a patient with AUB in the reproductive period at the outpatient stage

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6. Fig. 4. Algorithm for managing a patient with AUB in the late reproductive period at the outpatient stage

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