Abstract
Background
Normal menstrual periods last 3–6 days and involve blood loss of up to 80 ml. Menorrhagia is defined as menstrual periods lasting more than 7 days and/or involving
blood loss greater than 80 ml. The prevalence of abnormal uterine bleeding (AUB) is estimated at 11–13% in the
general population and increases with age, reaching 24% in those aged 36–40 years.
Investigation
A blood count for red cells + platelets to test for anemia is recommended on a first-line basis for women consulting
for AUB whose history and/or bleeding score justify it. A pregnancy test by an hCG
assay should be ordered. A speculum examination and Pap smear, according to the French
High Health Authority guidelines should be performed early on to rule out any cervical
disease. Pelvic ultrasound, both abdominal (suprapubic) and transvaginal, is recommended
as a first-line procedure for the etiological diagnosis of AUB. Hysteroscopy or hysterosonography
can be suggested as a second-line procedure. MRI is not recommended as a first-line
procedure.
Treatment
In idiopathic AUB, the first-line treatment is medical, with efficacy ranked as follows:
levonorgestrel IUD, tranexamic acid, oral contraceptives, either estrogens and progestins
or synthetic progestins only, 21 days a month, or NSAIDs. When hormone treatment is
contraindicated or immediate pregnancy is desired, tranexamic acid is indicated. Iron
must be included for patients with iron-deficiency anemia. For women who do not wish
to become pregnant in the future and who have idiopathic AUB, the long-term efficacy
of conservative surgical treatment is greater than that of oral medical treatment.
Placement of a levonorgestrel IUD (or administration of tranexamic acid by default)
is recommended for women with idiopathic AUB. If this fails, a conservative surgical
technique must be proposed; the choices include second-generation endometrial ablation
techniques (thermal balloon, microwave, radiofrequency), or, if necessary, first-generation
techniques (endometrectomy, roller-ball). A first-line hysterectomy is not recommended
in this context. Should a hysterectomy be selected for functional bleeding, it should
be performed by the vaginal or laparoscopic routes.
Keywords
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Article info
Publication history
Published online: July 20, 2010
Accepted:
July 2,
2010
Received:
May 31,
2010
Identification
Copyright
© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
