Abnormal uterine bleeding: a management algorithm

Area of Science:

• Gynecology
• Evidence-based Medicine
• Clinical Practice Guidelines

Background:

• Abnormal uterine bleeding (AUB) is a prevalent gynecological issue with complex management challenges.
• Existing guidelines for AUB are often difficult to implement due to their complexity.
• There is a need for concise, practical guidelines for AUB management.

Purpose of the Study:

• To develop a concise and comprehensive algorithm for managing abnormal uterine bleeding (AUB) in women between menarche and menopause.
• To create a guideline that bridges the gap between systematic literature reviews and actual clinical practice.
• To provide primary care physicians with effective AUB management strategies.

Main Methods:

• A systematic literature review was conducted using MEDLINE to identify relevant research on AUB.
• An initial algorithm was drafted based on the literature review.
• The algorithm was iteratively refined by comparing it with the care of 300 patients in a university gynecology clinic.
• Discrepancies were discussed and resolved by investigators (family physicians and gynecologists) through audiotaped meetings.

Main Results:

• A final algorithm was established after three iterations, aligning with observed clinical practices and evidence.
• The algorithm categorizes AUB into four types: irregular bleeding, heavy regular bleeding (menorrhagia), severe acute bleeding, and contraceptive-associated bleeding.
• Management strategies involve simultaneous diagnostic and treatment interventions.

Conclusions:

• The developed algorithm offers a practical approach to managing abnormal uterine bleeding.
• It supports primary care physicians in applying evidence-based and clinically relevant AUB management strategies.
• The guideline aims to improve the consistency and effectiveness of AUB care for women of reproductive age.