Clinical bleeding patterns and management of abnormal uterine bleeding in non-pregnant women: a cross-sectional study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20234079Keywords:
Abnormal uterine bleeding, AUB management, PALM-COIENAbstract
Background: Around 10 to 15 percent of women go through instances of unusual bleeding from their uterus at some point during their reproductive years. Additionally, up to one-third of women may come across irregular menstrual cycles. These irregularities often occur during two crucial phases in a woman's life: firstly, at the beginning of menstruation, which is known as menarche, and secondly, during the transition leading up to menopause, referred to as perimenopause. Aim of study was to determine the clinical bleeding patterns in nonpregnant women and its management.
Methods: During the study period spanning from November 2021 to December 2022, a cross-sectional study examined non-pregnant females aged 15 to 55 experiencing abnormal vaginal bleeding (AUB) who provided consent. However, certain exclusion criteria were established to ensure that the study's findings remained pertinent to the target population. Females exhibiting vaginal bleeding attributed to pregnancy or pregnancy-related factors were excluded from the study, as were those with vaginal bleeding stemming from vaginitis, cervical benign, premalignant, or malignant conditions, or traumatic causes. Descriptive statistics were employed in the study.
Results: Structural causes [PALM] accounts for 71 (61%) of cases whereas non-structural causes of chronic AUB account for 44 (39%) of cases. AUB-L, 45 (39.2%) was the most frequent finding in females with AUB. The second most common causes are AUB-O 23 (20%) followed by AUB-A 14 (12.2%), AUB-C 08(7%), AUB-M 07 (6.1%), AUB-E 06 (5.2%), AUB-P and AUB-I in 05 (4.3%) each and AUB-N 02 (1.7%).
Conclusions: Focusing on Abnormal Uterine Bleeding (AUB), it was observed that AUB-L, attributed to leiomyomas, emerged as the most prevalent cause among affected females. Subsequently, AUB-O, arising from ovulatory dysfunction, and aub-a, linked to adenomyosis, ranked as the second and third most common causes, respectively. Among the clinical manifestations of AUB, prolonged bleeding was identified as the most frequent symptom, followed closely by heavy bleeding.
References
Fraser IS, Critchley HO, Munro MG, Broder M. can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum. Reprod. 2007;22(3):635-43
Whitaker L, Critchely HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
Munro MG, Critchley HOD, Fraser IS., FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408.
Konar H. DC Dutta's textbook of gynecology. JP Medical Ltd; 2016.
Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183-94.
Farquhar C, Brosens I. Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):603-16.
Vaidya R, Vinayachandran S, Devi S, Prejisha B, Lekshminath G, Sreedharan S, et al. Prevalence of Abnormal Uterine Bleeding and its Associated Risk Factors in Women of Perimenopausal Age Group-A Retrospective Study. J Clin Diagnos Res. 2022;16(12).
Sajitha K, Padma SK, Shetty JK, KishanPrasad HL, Permi HS, Hegde P. Study of histopathological patterns of endometrium in abnormal uterine bleeding. CHRISMED J Healt Res. 2014;1(2):76-81.
Katuwal N, Gurung G, Rana A, Jha A. A clinicopathological study of dysfunctional uterine bleeding. J Pathol Nep. 2014;4(8):635-8.
Gubbala SD, Mattaparti DS. Clinico-pathological evaluation and etiological stratification of chronic AUB patients based on PALMCOEIN classification: A prospective study in tertiary care center of Nalgonda District. Int J Clin Diagnostic Pathol. 2019;2(1):174-81.
Rizvi G, Pandey H, Pant H, Chufal SS, Pant P. Histological correlation of adenomyosis and leiomyoma in hysterectomy specimens as the cause of abnormal uterine bleeding in women in different age groups in the Kumaon region: a retrospective study. J Midlife Health. 2013;(4):27–30
Muzaffa M, Akhtar KA, Yasmin S, Mahmood-Ur-Rehman, Iqbal W, Khan MA. Menstrual irregularities with excessive blood loss: A cinico-pathological correlation. J Pak Med Assoc. 2005;55(11):486-9.
Jairajpuri ZS, Rana S, Jetley S. Atypical uterine bleeding- A histopathological audit of endometrium. A study of 638 cases. Al Ameen J Med Sci. 2013;(6):21-2.
Sreelakshmi U, Subhashini T. Abnormal uterine bleeding in perimenopausal age group women: a study on clinicopathological evaluation and management. Int J Reproduct Contracep Obstet Gynecol. 2018;7(1):192-8.
Chennuru R, Potnuru R. Abnormal uterine bleeding in women of peri-menopausal age: a retrospective study. Int J Reproduct Contracep Obstet Gynecol. 2019;8(6):2407.
Afghan S, Yasmeen A. Abnormal uterine bleeding (AUB) a clinicopathological study of 150 cases. Ann Pak Inst Med Sci. 2013;9(4):201-4.
Gupta A, Rathore AM, Manaktala U, Rudingwa P. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. IJBAR. 2013;4(8):509-13.
Chennuru R, Potnuru R. Abnormal uterine bleeding in women of peri-menopausal age: a retrospective study. Int J Reproduct Contracep Obstet Gynecol. 2019;8(6):2407.
Radhika K, Gomathy E. Clinico-pathological correlation of AUB patients undergoing hysterectomy in a rural tertiary care centre. Indian J Obstet Gynecol Res. 2019;6(4):495-8.
Nayar SR, Thakur SS. -. J Obst and Gynec India. 1976;26:585–585
Jairajpuri ZS, Rana S, Jetley S. Atypical uterine bleeding- A histopathological audit of endometrium. A study of 638 cases. Al Ameen J Med Sci. 2013;(6):21-2.
Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/ menorrhagia. J Ayub Med Coll Abbottabad. 2009;21(2):60–3.
Mirza T, Akram S, Mirza A, Aziz S, Mirza T, Mustansar T. Histpathological pattern of abnormal uterine bleeding in endometrial biopsies. J Basic Appl Sci. 2012;8(1):114–7.
Patil SG, Bhute SB, Inamdar SA, Acharya NS, Shrivastava DS. Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathological correlation. J Gynecol Endoscop Surg. 2009;1(2):98-104.
Vaidya S, Lakhey M, Vaidya S, Sharma PK, Hirachand S, Lama S, et al. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J. 2013;15(1):74-.
Mutakha GS, Mwaliko E, Kirwa P. Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya. PloS one. 2020;15(12):e0243166.
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).
