Abnormal uterine bleeding

References

Key articles

Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. Abstract

National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. May 2021 [internet publication].Full text

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].Full text

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].Full text

American College of Obstetricians and Gynecologists. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Jul 2013 [internet publication].Full text

Reference articles

1. Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. Abstract

2. Fraser IS, Critchley HO, Broder M, et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011 Sep;29(5):383-90. Abstract

3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. May 2021 [internet publication].Full text

4. Fraser IS, Critchley HO, Munro MG, et al. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007 Mar;87(3):466-76.Full text  Abstract

5. Fraser I, Langham S, Uhl-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol. 2009;4(2):179-89.

6. Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract. 2004 May;54(502):359-63.Full text  Abstract

7. Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health. 1996 Feb;86(2):195-9.Full text  Abstract

8. Royal College of Obstetricians and Gynaecologists. National heavy menstrual bleeding audit: a national audit to assess patient outcomes and experiences of care for women with heavy menstrual bleeding in England and Wales. Second Annual Report. July 2012 [internet publication].Full text

9. Geary RS, Gurol-Urganci I, Kiran A, et al. Factors associated with receiving surgical treatment for menorrhagia in England and Wales: findings from a cohort study of the National Heavy Menstrual Bleeding Audit. BMJ Open. 2019 Feb 19;9(2):e024260.Full text  Abstract

10. UK Office for National Statistics. Statistical bulletin: who is having babies? December 2009 [internet publication].Full text

11. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].Full text

12. Salim S, Won H, Nesbitt-Hawes E, et al. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011 Sep-Oct;18(5):569-81. Abstract

13. Haimov-Kochman R, Deri-Hasid R, Hamani Y, et al. The natural course of endometrial polyps: could they vanish when left untreated? Fertil Steril. 2009 Aug;92(2):828.e11-2.Full text  Abstract

14. Bergholt T, Eriksen L, Berendt N, et al. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001 Nov;16(11):2418-21.Full text  Abstract

15. Abbott JA. Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2017 Apr;40:68-81. Abstract

16. Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100-7. Abstract

17. Chodankar R, Allison J. New horizons in fibroid management. Curr Obstet Gynecol Rep. 2018 Jun;7(2):106-11.

18. Cancer Research UK. Uterine cancer statistics. 2017 [internet publication].Full text

19. Deligeoroglou E, Karountzos V. Abnormal Uterine bleeding including coagulopathies and other menstrual disorders. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:51-61. Abstract

20. Shankar M, Lee CA, Sabin CA, et al. von Willebrand disease in women with menorrhagia: a systematic review. BJOG. 2004 Jul;111(7):734-40.Full text  Abstract

21. Kouides PA, Conard J, Peyvandi F, et al. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril. 2005 Nov;84(5):1345-51.Full text  Abstract

22. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016 Jul;34:54-65.Full text  Abstract

23. Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015 Nov-Dec;21(6):748-61.Full text  Abstract

24. Elmaoğulları S, Aycan Z. Abnormal uterine bleeding in adolescents. J Clin Res Pediatr Endocrinol. 2018 Jul 31;10(3):191-7.Full text  Abstract

25. Mullins TL, Miller RJ, Mullins ES. Evaluation and management of adolescents with abnormal uterine bleeding. Pediatr Ann. 2015 Sep;44(9):e218-22. Abstract

26. Cheong Y, Cameron IT, Critchley HOD. Abnormal uterine bleeding. Br Med Bull. 2017 Sep 1;123(1):103-14.Full text  Abstract

27. Bofill Rodriguez M, Lethaby A, Low C, et al. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Aug 14;(8):CD001016.Full text  Abstract

28. Abdel-Aleem H, d'Arcangues C, Vogelsong KM, et al. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database Syst Rev. 2013 Oct 21;(10):CD003449.Full text  Abstract

29. The Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists. FSRH clinical guideline: problematic bleeding with hormonal contraception. July 2015 [internet publication].Full text

30. Munro MG, Critchley HOD, Fraser IS, et al. 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 Dec;143(3):393-408. [Erratum in: Int J Gynecol Obstet. 2019 Feb;144(2):237.]Full text  Abstract

31. Hoffman MK, Meilstrup JW, Shackelford DP, et al. Arteriovenous malformations of the uterus: an uncommon cause of vaginal bleeding. Obstet Gynecol Surv. 1997 Dec;52(12):736-40. Abstract

32. Borges LM, Scapinelli A, de Baptista Depes D, et al. Findings in patients with postmenstrual spotting with prior cesarean section. J Minim Invasive Gynecol. 2010 May-Jun;17(3):361-4. Abstract

33. Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol. 1995 Jan;14(1):16-20. Abstract

34. Chodankar R, Harpur A, Mahmood T. Heavy menstrual bleeding. Obstet Gynecol Reprod Med. 2018 Jul;28(7):196-202.

35. Kelly RW, King AE, Critchley HO. Cytokine control in human endometrium. Reproduction. 2001 Jan;121(1):3-19.Full text  Abstract

36. Maybin JA, Critchley HO, Jabbour HN. Inflammatory pathways in endometrial disorders. Mol Cell Endocrinol. 2011 Mar 15;335(1):42-51. Abstract

37. Critchley HO, Osei J, Henderson TA, et al. Hypoxia-inducible factor-1alpha expression in human endometrium and its regulation by prostaglandin E-series prostanoid receptor 2 (EP2). Endocrinology. 2006 Feb;147(2):744-53.Full text  Abstract

38. Maybin JA, Murray AA, Saunders PTK, et al. Hypoxia and hypoxia inducible factor-1α are required for normal endometrial repair during menstruation. Nat Commun. 2018 Jan 23;9(1):295.Full text  Abstract

39. Baird DT, Cameron ST, Critchley HO, et al. Prostaglandins and menstruation. Eur J Obstet Gynecol Reprod Biol. 1996 Dec;70(1):15-7. Abstract

40. Goodman NF, Cobin RH, Futterweit W, et al. American Association Of Clinical Endocrinologists, American College Of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 1. Endocr Pract. 2015 Nov;21(11):1291-300.Full text  Abstract

41. Stankiewicz M, Norman R. Diagnosis and management of polycystic ovary syndrome: A practical guide. Drugs. 2006;66(7):903-12. Abstract

42. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 740: gynecologic care for adolescents and young women with eating disorders. Jun 2018 [internet publication].Full text

43. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 705:​ mental health disorders in adolescents. Jul 2017 [internet publication].Full text

44. Goldsammler M, Merhi Z, Buyuk E. Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary-ovarian axis. Reprod Biol Endocrinol. 2018 May 9;16(1):45.Full text  Abstract

45. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].Full text

46. James AH, Kouides PA, Abdul-Kadir R, et al. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. 2009 Jul;201(1):12.e1-8.Full text  Abstract

47. American College of Obstetricians and Gynecologists. Committee opinion no. 785: screening and management of bleeding disorders in adolescents with heavy menstrual bleeding. Sep 2019 [internet publication].Full text

48. American College of Radiology. ACR appropriateness criteria: abnormal vaginal bleeding. 2020 [internet publication].Full text

49. Evans D, Goldstein S, Loewy A, et al. No. 385-indications for pelvic examination. J Obstet Gynaecol Can. 2019 Aug;41(8):1221-34. Abstract

50. American College of Obstetricians and Gynecologists. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Jul 2013 [internet publication].Full text

51. Braverman PK, Breech L; Committee on Adolescence. American Academy of Pediatrics. Clinical report - gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010 Sep;126(3):583-90.Full text  Abstract

52. Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2019 Apr 1;99(7):435-43.Full text  Abstract

53. American College of Obstetricians and Gynecologists. ACOG clinical consensus no. 3: general approaches to medical management of menstrual suppression. Sep 2022 [internet publication].Full text

54. Bofill Rodriguez M, Dias S, Jordan V, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database Syst Rev. 2022 May 31;5(5):CD013180.Full text  Abstract

55. James AH, Kouides PA, Abdul-Kadir R, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):124-34. Abstract

56. Hamani Y, Ben-Shachar I, Kalish Y, et al. Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura-induced severe uterine bleeding. Fertil Steril. 2010 Dec;94(7):2769.e13-5.Full text  Abstract

57. Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol. 2017 Jun;30(3):335-40. Abstract

58. O'Brien SH. Evaluation and management of heavy menstrual bleeding in adolescents: the role of the hematologist. Blood. 2018 Nov 14. pii: blood-2018-05-848739.Full text  Abstract

59. Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv. 2005 Nov;60(11):761-7. Abstract

60. Chodankar R, Critchley H. Abnormal uterine bleeding (including PALM COEIN classification). Obstet Gynaecol Reprod Med. 2019 April; 29(4):98-104.

61. Lethaby A, Hussain M, Rishworth JR, et al. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015 Apr 30;(4):CD002126.Full text  Abstract

62. Mentrikoski MJ, Shah AA, Hanley KZ, et al. Assessing endometrial hyperplasia and carcinoma treated with progestin therapy. Am J Clin Pathol. 2012 Oct;138(4):524-34.Full text  Abstract

63. Shulman LP, Nelson AL, Darney PD. Recent developments in hormone delivery systems. Am J Obstet Gynecol. 2004 Apr;190(4 Suppl):S39-48. Abstract

64. Grunloh DS, Casner T, Secura GM, et al. Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use. Obstet Gynecol. 2013 Dec;122(6):1214-21.Full text  Abstract

65. Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Physician. 2004 Apr 15;69(8):1915-26.Full text  Abstract

66. Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001016.Full text  Abstract

67. Hickey M, Higham JM, Fraser I. Progestogens with or without oestrogen for irregular uterine bleeding associated with anovulation. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD001895.Full text  Abstract

68. Lethaby A, Wise MR, Weterings MA, et al. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Feb 11;(2):CD000154.Full text  Abstract

69. Iyer V, Farquhar C, Jepson R. Oral contraceptive pills for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(2):CD000154.Full text  Abstract

70. Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000400.Full text  Abstract

71. Mendonça LL, Khamashta MA, Nelson-Piercy C, et al. Non-steroidal anti-inflammatory drugs as a possible cause for reversible infertility. Rheumatology (Oxford). 2000 Aug;39(8):880-2.Full text  Abstract

72. Bryant-Smith AC, Lethaby A, Farquhar C, et al. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2018 Apr 15;(4):CD000249.Full text  Abstract

73. Stocker L, Umranikar A, Moors A, et al. An overview of hysteroscopy and hysteroscopic surgery. Obstet Gynaecol & Reprod Med. 2013 May;23(5):146-53.

74. Bofill Rodriguez M, Lethaby A, Fergusson RJ. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2021 Feb 23;2:CD000329.Full text  Abstract

75. Kohn JR, Shamshirsaz AA, Popek E, et al. Pregnancy after endometrial ablation: a systematic review. BJOG. 2018 Jan;125(1):43-53.Full text  Abstract

76. Cooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual bleeding: the HEALTH RCT. Health Technol Assess. 2019 Sep;23(53):1-108.Full text  Abstract

77. Chodankar R, Chamberlain J, Rose K. Implications of obesity on gynaecological surgery. Obstet Gynaecol & Reprod Med. 2019 Jul;29(7):195-200​.

78. Yong PJ, Thurston J, Singh SS, et al. Guideline no. 386-gynaecologic surgery in the obese patient. J Obstet Gynaecol Can. 2019 Sep;41(9):1356-70.e7. Abstract

79. Matteson KA, Abed H, Wheeler TL 2nd, et al. A systematic review comparing hysterectomy with less-invasive treatments for abnormal uterine bleeding. J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):13-28.Full text  Abstract

80. Gupta JK, Sinha A, Lumsden MA, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014 Dec 26;(12):CD005073.Full text  Abstract

81. Bofill Rodriguez M, Lethaby A, Grigore M, et al. Endometrial resection and ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Jan 22;(91):CD001501.Full text  Abstract

82. Electronic Medicines Compendium. Decapeptyl SR 3mg. Nov 2022 [internet publication].Full text

83. Takeuchi H, Kobori H, Kikuchi I, et al. A prospective randomized study comparing endocrinological and clinical effects of two types of GnRH agonists in cases of uterine leiomyomas or endometriosis. J Obstet Gynaecol Res. 2000 Oct;26(5):325-31. Abstract

84. Moroni RM, Martins WP, Ferriani RA, et al. Add-back therapy with GnRH analogues for uterine fibroids. Cochrane Database Syst Rev. 2015 Mar 20;(3):CD010854.Full text  Abstract

85. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins —Gynecology. Practice bulletin no. 81: endometrial ablation. May 2007 [internet publication].

86. Lefebvre G, Allaire C, Jeffrey J, et al. No. 109-Hysterectomy. J Obstet Gynaecol Can. 2018 Jul;40(7):e567-79. Abstract

87. The Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists. FSRH Service Standards for sexual and reproductive healthcare. September 2016 [internet publication].Full text

88. National Institute for Health and Care Excellence. Laparoscopic techniques for hysterectomy. November 2007 [internet publication].Full text  Abstract

89. National Institute for Health and Care Excellence. Fluid-filled thermal balloon and microwave endometrial ablation techniques for heavy menstrual bleeding. April 2004 [internet publication].Full text

90. Farland LV, Rice MS, Degnan WJ 3rd, et al. Hysterectomy with and without oophorectomy, tubal ligation, and risk of cardiovascular disease in the Nurses' Health Study II. J Womens Health (Larchmt). 2023 Jul;32(7):747-56. Abstract

91. Wenger NK, Lloyd-Jones DM, Elkind MSV, et al. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: a presidential advisory from the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-71.Full text  Abstract

92. O'Kelly AC, Michos ED, Shufelt CL, et al. Pregnancy and reproductive risk factors for cardiovascular disease in women. Circ Res. 2022 Feb 18;130(4):652-72.Full text  Abstract

Use of this content is subject to our disclaimer