Published: 2021-03-24

Recent trends in managing abnormal uterine bleeding

Shruthi Ananthula, Ushadevi Gopalan, Sivan Kumar Kumarapillai


Abnormal uterine bleeding is one of the most common problems among women of reproductive age. It is an important health care problem and may cause physiological as well as psycological stress impairing the quality of life. The aim of this review was to present various management options for women suffering from menorrhagia. An extensive electronic literature search was done using search engines like PubMed and Google scholar using the mesh terms/ key words like “abnormal uterine bleeding, menorrhagia, medical management, hysterectomy” to identify trials and reviews on management of abnormal uterine bleeding. Various pharmacological and surgical treatment options are available, among medical therapy Tranexamic acid being most effective. Second-generation endometrial ablation techniques are effective and safe alternatives compared to first-generation devices. Hysterectomy should be considered as a last resort in management of AUB as this major surgery is associated with high morbidity and mortality rates. Thus role of clinician is to counsel every women and provide full information regarding both medical as well as surgical treatment modalities available and facilitate them in making an appropriate choice.


Abnormal uterine bleeding, Medical, Surgical, Hysterectomy

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Farrukh JB, Towriss K, McKee N. Abnormal uterine bleeding: Taking the stress out of controlling the flow. Can Fam Physician. 2015;61(8):693-7.

Hapangama DK, Bulmer JN. Pathophysiology of heavy menstrual bleeding. Womens Health. 2016;12(1):3-13.

Hallberg L, Nilsson L. Determination of menstrual blood loss. Scand J Clin Lab Invest. 1964;16:244-8.

Higham JM, Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;97:734-9.

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

Dijkuizen FPHLJ, Vries LID, Mol BWJ. Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities. Ultrasound Obstet Gynecol. 2000;15:372-6.

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

Kadir RA, Lukes AS, Kouides PA, Fernandez H, Goudemand J. Management of excessive menstrual bleeding in women with hemostatic disorders. Fertil Steril. 2005;84(5):1352-9.

Lethaby A, Augood C, Duckitt K, Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;(4):CD000400.

Gleeson NC, Buggy F, Sheppard BL, Bonnar J. The effect of Tranexamic acid on measured menstrual loss and endometrial Fibrinolytic enzymes in dysfunctional uterine bleeding. Acta Obstet Gynecol Scand. 1994;73(3):274-7.

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

Fraser IS, Kovacs GT. The efficacy of non-contraceptive uses for hormonal contraceptives. Med J Aust. 2003;178(12):621-3.

Fraser IS, Parke S, Mellinger U, Machlitt A, Serrani M, Jensen J. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011;16(4):258-69.

Curtis KM, Tepper NK, Jatlaoui TC, Bibee BE, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use. MMWR Recomm Rep. 2016;65(3):1-103.

Beaumont HH, Augood C, Duckitt K, Lethaby A. Danazol for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;3:CD001017.

Hickey M, Higham JM, Fraser I. Progestogens versus oestrogens and progestogens for irregular uterine bleeding associated with anovulation. Cochrane Database Syst Rev. 2007;4:CD001895.

Lethaby A, Cooke I, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005;4:CD002126.

Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2001;2:CD000547.

Cetin NN, Karabacak O, Korucuoglu U, Karabacak N. Gonadotropin-releasing hormone analog combined with a low-dose oral contraceptive to treat heavy menstrual bleeding. Int J Gynaecol Obstet. 2009;104(3):236-9.

Mukherjee K, Jones K. The treatment of dysfunctional uterine bleeding with the Mirena IUS: a survival analysis. Gynecol Surgery. 2005;2(4):251-4.

Hurskainen R, Teperi J, Rissanen P. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357(9252):273-7.

Kouides PA, Byams VR, Philipp CS, Stein SF, Heit JA, Lukes AS, et al. Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid. Br J Haematol. 2009;145(2):212-20.

Chawla SK, Bucha A, Sethi A, Puar NS, Paliwal V. Use of Centchroman (Saheli) in conservative management of Menorrhagia: Our experience. Ind J Obstet Gynecol Res. 2017;4(3):220-4.

Bhattacharya S, Cameron IM, Parkin DE. A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia. Br J Obstet Gynaecol. 1997;104:601-7.

Lethaby A, Hickey M, Garry R, Penninx J. Endometrial resection/ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009;4:CD001501.

Vilos G, Edris F. Second-generation endometrial ablation technologies: the hot liquid ballons. Best Pract Res Clin Obstet Gynaecol. 2007;21(6):947-67.

Leal GJ, Pena A, Donovan A. Clinical evaluation of a third-generation thermal uterine balloon therapy system for menorrhagia coupled with curettage. J Min Inv Gynecol. 2010;17(1):82-90.

Gurtcheff SE, Sharp HT. Complications associated with global endometrial ablation: the utility of the MAUDE database. Obstet Gynecol. 2003;102:1278-82.

Weisberg M. Complications associated with global endometrial ablations: the utility of the MAUDE database. Obstet Gynecol. 2004;103:995.

Jameel JK, Ahmed T, Noble W, Philips K, Tised J. Microwave endometrial ablation (MEA) and bowel injury. Gynecol Surgery. 2005;2(2):131-3.

Marlies B. Second generation endometrial ablation treatment: Novasure. Best Pract Res Clin Obstet Gynaecol. 2005;21(6):989-94.

Badia DC, Nyirjesy P, Ata A. Endometrial ablation devices: review of a manufacturer and user facility device experience database. JMZIG. 2007;14:436-41.

Lumsden MA, Twaddle S, Hawthorn R. A randomized comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. Br J Obstet Gynaecol. 2000;107:1386-91.