Minimum Set of Investigations Required for Evaluation of Abnormal Uterine Bleeding in Low Resource Setting

Abnormal uterine bleeding (AUB) belongs to the most common gynecological disorders that largely affect the health of women, especially living in low-resource countries. Efficiency and effectiveness in assessment of AUB is essential to make sure that appropriate and differed treatment is provided.

It was a prospective study undertaken in one of the low resource healthcare facilities within a span of six month. Two hundred women were selected with the case of AUB. Evaluation procedure comprised of having a full medical history, physical examination, complete blood count (CBC), pelvic ultrasound, endometrial biopsy, and the serum thyroid-stimulating hormone (TSH). The effectiveness and cost efficiency of these studies were also reviewed in order to establish the minimum combination that can be used.

The so-called basic set of investigations worked well with 150 (75%) of the 200 participants: 150 (75%) AUB was effectively assessed with the help of medical history, physical examination, CBC, and ultrasound of the pelvis. Diagnosis of endometrial hyperplasia or malignancy required diagnosis of endometrial biopsy in 40 (20) cases. TSH levels in the serum were critical in determining the dysfunction of the thyroid in 10 (5%) incidences. The analysis of the cost demonstrated that omitting endometrial biopsy and TSH testing in a first-line assessment protocol lowered the expenses by 30%, without impairing the accuracy regarding the diagnosis in most of the patients.

The triage of AUB in the low-resource environment could be successfully addressed with a minimal number of investigations, which could involve the medical history, physical examination, CBC, and pelvic ultrasound. Endometrial biopsy and TSH level must remain as a test with special clinical indications.