Abnormal Uterine Bleeding in Premenopausal Women

Area of Science:

• Gynecology
• Reproductive Medicine
• Women's Health

Background:

• Abnormal uterine bleeding (AUB) is a prevalent gynecological symptom affecting women's quality of life.
• The PALM-COEIN classification system categorizes AUB causes into structural (PALM) and non-structural (COEIN) etiologies.
• Accurate diagnosis and classification are crucial for effective management of AUB.

Purpose of the Study:

• To outline the diagnostic and management strategies for abnormal uterine bleeding.
• To review the classification system and treatment options for AUB.
• To emphasize evidence-based approaches for managing AUB in women.

Main Methods:

• Evaluation includes detailed history, pelvic examination, and laboratory tests (pregnancy test, CBC).
• Endometrial sampling is recommended for women ≥45 years or younger patients with specific risk factors.
• Transvaginal ultrasonography is the primary imaging modality for suspected structural causes or persistent symptoms.

Main Results:

• Medical management is the preferred initial approach for hemodynamically stable patients to preserve fertility.
• The levonorgestrel-releasing intrauterine system is the most effective long-term medical treatment for heavy menstrual bleeding.
• Surgical options like hysterectomy, endometrial ablation, myomectomy, polypectomy, and uterine artery embolization are available for specific cases.

Conclusions:

• A systematic approach using PALM-COEIN classification guides AUB diagnosis and treatment.
• Medical management, particularly with the levonorgestrel IUD, offers effective and fertility-sparing options for AUB.
• Both medical and surgical interventions are available, with treatment selection based on patient stability, etiology, and fertility desires.