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Approach to diagnosis and management of abnormal uterine bleeding
Deanna E Telner1, Difat Jakubovicz
1Toronto East General Hospital and Department of Family and Community Medicine, University of Toronto, Ontario. deanna.telner@utoronto.ca
Insights
Primary care physicians can manage abnormal uterine bleeding (AUB) effectively. This approach aids in diagnosing causes and selecting appropriate treatments, improving patient outcomes and knowing when to refer for specialist care.
Area of Science:
- Women's Health
- Primary Care Medicine
- Gynecology
Background:
- Abnormal uterine bleeding (AUB) is a common gynecological complaint in primary care.
- Evaluation and management require a systematic approach to differentiate causes.
Observation:
- Premenopausal AUB can stem from ovulatory dysfunction, anovulation, or anatomical issues.
- Postmenopausal bleeding, while often due to atrophic vaginitis, necessitates investigation for malignancy.
Findings:
- A range of hormonal and nonhormonal treatments are available for AUB.
- Treatment decisions should integrate patient preferences, potential side effects, and physician familiarity.
- Endometrial carcinoma risk exists in premenopausal women, especially those with risk factors.
Implications:
- A structured primary care approach enables effective in-office management of most AUB cases.
- This strategy empowers family physicians to identify and manage AUB appropriately, and to recognize when specialist referral is necessary.
Objective:
To present a primary care approach to evaluating and managing abnormal uterine bleeding.
Sources Of Information:
Literature searches were conducted on MEDLINE from 1996 to November 2004, EMBASE from 1996 to January 2005, the Cochrane Database of Systematic Reviews from the 4th quarter of 2004 to the 3rd quarter of 2005, guideline advisory committee databases, the Canadian Medical Association Infobase, and Clinical Evidence. The quality of evidence ranged from level I to III.
Main Message:
Premenopausal abnormal uterine bleeding can be ovulatory, anovulatory, or anatomic. A variety of hormonal and nonhormonal treatments are available. Patients' preferences, side effects, and physicians' comfort should be considered when making treatment decisions. One in 4 cases of endometrial carcinoma occur in premenopausal women, so it is important to investigate women with risk factors. While postmenopausal bleeding is most commonly caused by atrophic vaginitis, bleeding should be investigated to rule out endometrial and cervical carcinoma.
Conclusion:
A primary care approach to medical management of abnormal uterine bleeding can help family physicians treat most women in the office as well as help physicians know when to refer women for specialist care.
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