Optimizing treatment approaches for patients with abnormal uterine bleeding
Molotkov A.S., Yarmolinskaya M.I., Tsypurdeeva A.A.
Abnormal uterine bleeding (AUB) is one of the most common symptoms in gynecological practice. AUB is nearly always a condition that reduces the quality of life and requires medical care.
Objective: To highlight modern approaches to the diagnosis and treatment of AUB, to develop an algorithm for the management of patients from various groups.
Materials and methods: The databases and information resources, namely eLibrary and PubMed, have been searched for publications, systematic reviews and meta-analyses using the words “abnormal uterine bleeding” and “profuse menstrual bleeding” for the period 2017–2023.
Results: Approaches to diagnosis and treatment directly depend on the nature of AUB, the cause of bleeding and its effect on hemodynamics. In case of acute AUB, the main task is to stop bleeding and stabilize the patient’s condition. In chronic bleeding, surgery is performed in addition to medical treatment. According to the Cochrane review and network meta-analysis, levonorgestrel-releasing IUD, antifibrinolytics, and progestogens in prolonged cyclic mode can be used as first-line therapy that effectively reduces blood loss. When prescribing hormonal therapy, it is recommended to explain the importance of following the instructions and consistency of taking the medications during the entire period of treatment. The effectiveness of progestogen therapy, which can contribute to the restoration of the physiological menstrual cycle, is of particular interest. Among the progestogens, dydrogesterone takes a special place as it is possible to personalize the treatment of patients due to high selectivity and good safety profile of dydrogesterone.
Conclusion: Progestogens remain some of the main medications for the treatment and prevention of AUB. When consulting patients, it is necessary to clarify their reproductive plans or the need for contraception as this information can help to personalize treatment. In prolonged cyclic mode, dydrogesterone can help normalize the menstrual cycle, including in patients planning pregnancy.
Authors’ contributions: Molotkov A.S., Yarmolinskaya M.I., Tsypurdeeva A.A. – developing the concept and design of the study, collecting, processing, analyzing the material and editing sources, writing the text, editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Molotkov A.S., Yarmolinskaya M.I., Tsypurdeeva A.A. Optimizing treatment approaches for patients with abnormal uterine bleeding.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (1): 140-152 (in Russian)
https://dx.doi.org/10.18565/aig.2023.301
Keywords
uterine bleeding
AUB
abnormal uterine bleeding
PALM-COEIN
progestogens
dydrogesterone
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Received 22.12.2023
Accepted 17.01.2024
About the Authors
Arseny S. Molotkov, Associate Professor, PhD, Senior Researcher at the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3; Associate Professor performing medical work, Departments of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 199034, Russia, St. Petersburg, Universitetskaya nab., 7/9, arseny.molotkov@gmail.comMaria I. Yarmolinskaya, Professor of RAS, Dr. Med. Sci., Head of the Department of Gynecology and Endocrinology, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, 199034, Russia, St. Petersburg, Mendeleyevskaya liniya, 3; Professor, Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, 191015, Russia, St. Petersburg, Kirochnaya str., 41, m.yarmolinskaya@gmail.com
Anna A. Tsypurdeeva, Associate Professor, Ph.D., Senior Researcher at the Department of Gynecology and Endocrinology and Head of Gynecology Department I with an operating unit, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, 199034, Russia, St. Petersburg, Mendeleevskaya line, 3; Associate Professor performing medical work, Departments of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 199034, Russia, St. Petersburg, Universitetskaya nab., 7/9, tsypurdeeva@mail.ru
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