Optimizing treatment approaches for patients with abnormal uterine bleeding

Molotkov A.S., Yarmolinskaya M.I., Tsypurdeeva A.A.

1) D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia; 2) St. Petersburg State University, St. Petersburg, Russia; 3) I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, St. Petersburg, Russia

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)


uterine bleeding
abnormal uterine bleeding


  1. Савельева Г.М., Сухих Г.Т., Серов В.Н., Манухин И.Б., Радзинский В.Е., ред. Гинекология. Национальное руководство. 2-е изд. М.: ГЭОТАР-Медиа; 2017. 1048 с. [Savelyeva G.M., Sukhikh G.T., Serov V.N., Manukhin I.B., Radzinsky V.E., ed. Gynecology. National Guide. 2nd ed. Moscow: GEOTAR-Media; 2017. 1048 p. (in Russian)].
  2. Соловьева А.В., Ермоленко К.С. Дифференцированный подход к выбору терапии у женщин с аномальными маточными кровотечениями. Акушерство и гинекология. 2018; 3: 157-60. [Solovyeva A.V., Ermolenko K.S. Differentiated approach to choosing therapy for women with abnormal uterine bleeding. Obstetrics and Gynecology. 2018; (3): 157-60. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.3.157-160.
  3. Улумбекова Г.Э., Худова И.Ю. Оценка демографического, социального и экономического эффекта применения гормональной терапии при эндометриозе и аномальных маточных кровотечениях. ОРГЗДРАВ: новости, мнения, обучение. Вестник ВШОУЗ. 2022; 8(1): 82-113. [Ulumbekova G.E., Khludova I.Yu. Demographic, social and economic effects of hormonal therapy in endometriosis and abnormal uterine bleeding. HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ. 2022; 8(1): 82-113. (in Russian)]. https://dx.doi.org/10.33029/2411-8621-2022-8-1-82-113.
  4. Министерство здравоохранения Российской Федерации. Клинические рекомендации «Аномальные маточные кровотечения». 2021. [Ministry of Health of the Russian Federation. Clinical guidelines "Abnormal uterine bleeding." 2021. (in Russian)].
  5. Атарбаева М.Д., Каусова Г.К., Атарбаева В.Ш. К вопросу организации преемственности медицинской помощи населению. Вестник Казахского Национального медицинского университета. 2017; 1: 490-4. [Atarbaeva M.D., Kausova G.K., Atarbaeva V.Sh. Turning to the question of the organization of portability of medical care to the population. Vestnik KazNMU. 2017; 1: 490-4. (in Russian)].
  6. Yaşa C., Güngör Uğurlucan F. Approach to abnormal uterine bleeding in adolescents. J. Clin. Res. Pediatr. Endocrinol. 2020; 12(Suppl. 1): 1-6. https://dx.doi.org/10.4274/jcrpe.galenos.2019.2019.S0200.
  7. Perelló J, Rius Tarruella J, Calaf J. Heavy menstrual bleeding and its detection in clinical practice. Med. Clin. (Barc). 2021; 157(7): 332-8.https://dx.doi.org/10.1016/j.medcli.2021.02.006.
  8. Munro M.G., Balen A.H., Cho S., Critchley H.O.D., Díaz I., Ferriani R. et al.; FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility. The FIGO Ovulatory Disorders Classification System. Hum. Reprod. 2022; 37(10): 2446-64. https://dx.doi.org/10.1093/humrep/deac180.
  9. Cheong Y., Cameron I.T., Critchley H.O.D. Abnormal uterine bleeding. Br. Med. Bull. 201; 123(1): 103-14. https://dx.doi.org/10.1093/bmb/ldx027. Erratum in: Br. Med. Bull. 2019; 131(1): 119.
  10. Borzutzky C., Jaffray J. Diagnosis and management of heavy menstrual bleeding and bleeding disorders in adolescents. JAMA Pediatr. 2020; 174(2): 186-94. https://dx.doi.org/10.1001/jamapediatrics.2019.5040.
  11. Munro M.G., Critchley H.O.D., Fraser I.S.; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int. J. Gynaecol. Obstet. 2018; 143(3): 393-408. https://dx.doi.org/10.1002/ijgo.12666. Erratum in: Int. J. Gynaecol. Obstet. 2019; 144(2): 237.
  12. Benetti-Pinto C.L., Rosa-E-Silva A.C.J.S., Yela D.A., Soares Júnior J.M. Abnormal uterine bleeding. Rev. Bras. Ginecol. Obstet. 2017; 39(7): 358-68. https://dx.doi.org/10.1055/s-0037-1603807.
  13. Deligeoroglou E., Karountzos V. Abnormal uterine bleeding including coagulopathies and other menstrual disorders. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 48: 51-61. https://dx.doi.org/10.1016/j.bpobgyn.2017.08.016.
  14. Moon L.M., Perez-Milicua G., Dietrich J.E. Evaluation and management of heavy menstrual bleeding in adolescents. Curr. Opin. Obstet. Gynecol. 2017; 29(5): 328-36. https://dx.doi.org/10.1097/GCO.0000000000000394.
  15. Jewson M., Purohit P., Lumsden M.A. Progesterone and abnormal uterine bleeding/menstrual disorders. Best Pract. Res. Clin. Obstet. Gynaecol. 2020; 69: 62-73. https://dx.doi.org/10.1016/j.bpobgyn.2020.05.004.
  16. Wouk N., Helton M. Abnormal uterine bleeding in premenopausal women. Am. Fam. Physician. 2019; 99(7): 435-43.
  17. Haamid F., Sass A.E., Dietrich J.E. Heavy menstrual bleeding in adolescents. J. Pediatr. Adolesc. Gynecol. 2017; 30(3): 335-40. https://dx.doi.org/10.1016/j.jpag.2017.01.002. Erratum in: J. Pediatr. Adolesc. Gynecol. 2017; 30(6): 665.
  18. Kaunitz A.M. Abnormal uterine bleeding in reproductive-age women. JAMA. 2019; 321(21): 2126-27. https://dx.doi.org/10.1001/jama.2019.5248.
  19. Bofill Rodriguez M., Dias S., Jordan V., Lethaby A., Lensen S.F., Wise M.R. et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database Syst. Rev. 2022; 5(5): CD013180. https://dx.doi.org/10.1002/14651858.CD013180.pub2.
  20. Dozortsev D., Pellicer A., Diamond M.P. Progesterone is a physiological trigger of ovulatory gonadotropins. Fertil. Steril. 2020; 113(5): 923-4.https://dx.doi.org/10.1016/j.fertnstert.2019.12.024.
  21. Dozortsev D.I., Diamond M.P. Luteinizing hormone-independent rise of progesterone as the physiological trigger of the ovulatory gonadotropins surge in the human. Fertil. Steril. 2020; 114(2): 191-9. https://dx.doi.org/10.1016/j.fertnstert.2020.06.016.
  22. Плавинский С.Л., Баринова А.Н., Озолиня Л.А. Нежелательные последствия использования гормональных средств. Анализ фармакоэпидемиологических исследований и баз спонтанных отчетов. Вопросы гинекологии, акушерства и перинатологии. 2019; 18(6): 92-9. [Plavinskiy S.L., Barinova A.N., Ozolinya L.A. Adverse outcomes of using hormonal drugs. An analysis of pharmacoepidemiological research works and spontaneous reporting databases. Gynecology, Obstetrics and Perinatology. 2019; 18(6): 92-9. (in Russian)]. https://dx.doi.org/10.20953/1726-1678-2019-6-92-99.
  23. Андреева Е.Н., Шереметьева Е.В., Прилепская В.Н. Национальные медицинские критерии приемлемости методов контрацепции 2023: фокус на сохранение репродуктивного здоровья женщин. Гинекология. 2023; 25(2): 124-32. [Andreeva E.N., Sheremetyeva E.V., Prilepskaya V.N. National medical eligibility criteria for contraceptive use 2023: focus on women's reproductive health: A review. Gynecology. 2023; 25(2): 124-32. (in Russian)].https://dx.doi.org/10.26442/20795696.2023.2.202236.
  24. Бебнева Т.Н., Дикке Г.Б. Отвечая потребностям подростков. В тренде – пролонгированная контрацепция, в фокусе – качество консультирования. Фарматека. 2014; 12(285): 22-7. [Bebneva T.N., Dikke G.B. responding to the needs of adolescents. Trend to the prolonged contraception, focus on quality of advice. Farmateka. 2014; 12(285): 22-7. (in Russian)].
  25. Купина А.Д., Петров Ю.А., Шаталов А.Е. Возможные побочные эффекты и осложнения при применении внутриматочных контрацептивов. Международный журнал прикладных и фундаментальных исследований. 2019; 10-1: 132-6. [Kupina A.D., Petrov Yu.A., Shatalov A.E. Possible adverse effects and complications in the use of intrauterine contraceptives. International Journal of Applied and Fundamental Research. 2019; (10-1): 132-6. (in Russian)].
  26. Уварова Е.В. Внутриматочная система нового поколения с левоноргестрелом для контрацепции у нерожавших женщин. Репродуктивное здоровье детей и подростков. 2021; 17(4): 65-70. [Uvarova E.V. A new generation intrauterine system with levonorgestrel for contraception in unborn women. Pediatric and Adolescent Reproductive Health. 2021; 17(4): 65-70.(in Russian)]. https://dx.doi.org/10.33029/1816-2134-2021-17-4-65-70.
  27. Abul R., Selcuki N.F.T., Karadeniz O., Bahat P.Y. A comparison of the effects of oral dydrogesterone and levonorgestrel-releasing intrauterine device on quality of life and sexual function in patients with abnormal uterine bleeding. Arch. Gynecol. Obstet. 2023 Dec 27. https://dx.doi.org/10.1007/s00404-023-07315-y.
  28. Подзолкова Н.М., Татарчук Т.Ф., Дощанова А.М., Ешимбетова Г.З., Сумятина Л.В. Нормализация менструального цикла дидрогестероном. Акушерство и гинекология. 2018; 6: 70-6. [Podzolkova N.M., Tatarchuk T.F., Doshchanova A.M., Eshimbetova G.Z, Sumyatina L.V.Menstrual cycle normalization with dydrogesterone. Obstetrics and Gynecology. 2018; (6): 70-6. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.6.70-76.
  29. Fraser I.S., Parke S., Mellinger U., Machlitt A., Serrani M., Jensen J. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur. J. Contracept. Reprod. Health Care. 2011; 16(4): 258-69. https://dx.doi.org/10.3109/13625187.2011.591456.
  30. Кумыкова З.Х. Консультирование как ключевой фактор при выборе гормональной контрацепции. Акушерство и гинекология: новости, мнения, обучение. 2016; 2(12): 52-5. [Kumykova Z.Kh. Consulting as a key factor in the choice of hormonal contraception. Obstetrics and Gynecology: News, Opinions, Training. 2016; 2(12): 52-5.(in Russian)]..
  31. Чернуха Г.Е. Консультирование-залог правильного выбора метода контрацепции. Гинекология. 2014; 16(3): 22-6. [Chernukha G.E. Counselling as the guarantee of the correct contraception method selection. Gynecology. 2014; 16(3): 22-6. (in Russian)].
  32. Raymond C., Marin M.F., Juster R.P., Leclaire S., Bourdon O., Cayer-Falardeau S., Lupien S.J. Increased frequency of mind wandering in healthy women using oral contraceptives. Psychoneuroendocrinology. 2019; 101: 121-7. https://dx.doi.org/10.1016/j.psyneuen.2018.11.005.
  33. Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005; Suppl. 1: 3-63.https://dx.doi.org/10.1080/13697130500148875.

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.com
Maria 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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