Abnormal Uterine Bleeding May Be Best Evaluated by Menopausal Status

April 17, 2007 — The best approach to evaluating and treating abnormal uterine bleeding is to stratify women by premenopausal, perimenopausal, or postmenopausal status, according to a review published in the April issue of the Southern Medicine Journal. This review describes the differential diagnosis and diagnostic workup of abnormal uterine bleeding, defines an approach to etiology, and discusses treatment options.

"Disorders of the menstrual cycle are a common problem in ambulatory medicine, accounting for up to 30% of outpatient visits to gynecologists," write Sara B. Fazio, MD, and Amy N. Ship, MD, from the Harvard Medical School in Boston, Massachusetts. "Abnormal uterine bleeding describes bleeding that is excessive or outside the normal menstrual cycle. In the premenopausal woman, the differential diagnosis is broad, and pregnancy must always be considered."

In premenopausal women, after pregnancy has been excluded, the most important branch point is determining whether the bleeding is ovulatory or anovulatory. One of the most common causes of abnormal uterine bleeding is anovulation. In patients with anovulatory bleeding, treatment goals are to regulate cycles, minimize blood loss, and prevent iatrogenic complications from chronic unopposed estrogen treatment.

After determining the etiology of oligomenorrhea or amenorrhea, management should include maintenance of adequate estrogen to support bone health. The increasing incidence of endometrial hyperplasia and malignancy in the perimenopausal and postmenopausal population mandates a low threshold for endometrial assessment and referral to a gynecological specialist.

"Abnormal uterine bleeding is a common condition, and evaluation is best approached by stratifying into pre-, peri-, and postmenopausal status," the authors conclude. "Utilizing a systematic approach to the differential diagnosis will help to avoid a misdiagnosis. Much of the evaluation and treatment can be done in the office of the internist."

The authors have disclosed no relevant financial relationships.

South Med J. 2007;100:376-382.

Source: http://www.medscape.com/viewarticle/555284?src=mp