Management of Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) encompasses any deviation from normal menstrual patterns in frequency, duration or volume and poses substantial challenges for affected individuals and health systems worldwide. A structured diagnostic pathway begins with a detailed menstrual history, physical examination and basic haematological evaluation to exclude coagulopathies and anaemia. Imaging techniques, notably transvaginal ultrasound and office hysteroscopy, are increasingly used to identify structural causes such as fibroids, polyps or adenomyosis. The Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) PALM-COEIN classification facilitates categorisation into structural (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia) and non-structural (Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, Not otherwise classified) categories, guiding therapeutic selection. First-line management for heavy menstrual bleeding often includes oral tranexamic acid, non-steroidal anti-inflammatory drugs, combined hormonal contraception or a levonorgestrel-releasing intrauterine system (LNG-IUS). Intrauterine systems deliver high local progestogen concentrations, reduce blood loss by up to 90%, and preserve fertility. For those with contraindications to medical therapies or with treatment failure, endometrial ablation techniques (thermal, radiofrequency or cryoablation) offer minimally invasive alternatives. Hysterectomy remains the definitive surgical option for refractory cases or coexisting complex pathology. Beyond haemostasis, management must address quality of life, addressing fatigue, iron deficiency and psychosocial impacts through multidisciplinary care and patient education.

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Management of Abnormal Uterine Bleeding publication trend

The graph below shows the total number of articles in management of abnormal uterine bleeding across all publications each year (not limited to Nature Index journals).

Technical terms

Abnormal uterine bleeding (AUB): Any variation from normal menstrual patterns in timing, duration or volume.

FIGO PALM-COEIN classification: A system categorising AUB causes into structural (Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia) and non-structural (Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, Not otherwise classified) entities.

Heavy menstrual bleeding (HMB): Menstrual blood loss that interferes with a woman’s physical, social or emotional quality of life.

Levonorgestrel-releasing intrauterine system (LNG-IUS): A device delivering levonorgestrel directly to the endometrium, reducing menstrual blood loss.

Endometrial ablation: Minimally invasive techniques that destroy or remove the endometrial lining to decrease or cease menstrual bleeding.

References

1. Abnormal uterine bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology (2015).
2. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pakistan Journal of Medical Sciences (2019).
3. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Women's Health (2020).
4. Heavy menstrual bleeding diagnosis and medical management. Contraception and Reproductive Medicine (2017).
5. Approach to Abnormal Uterine Bleeding in Adolescents. Journal of Clinical Research in Pediatric Endocrinology (2020).