Abnormal Uterine Bleeding Drives Most Visits to Gynecologists

June 21, 2012

Washington, DC -- Abnormal uterine bleeding (AUB) is the cause of roughly one-third of all visits to the gynecologist among premenopausal women and more than 70% of office visits among peri- and postmenopausal women. The American College of Obstetricians and Gynecologists (The College) today released its first comprehensive guidance to ob-gyns for the screening, treatment, and management of AUB among reproductive-age women. 

A normal menstrual cycle typically lasts between 21 and 35 days, with menstruation generally lasting for five days. AUB describes bleeding that is more or less frequent or heavier than normal or menstrual cycles that are shorter or longer than average. In reproductive-age women, causes of AUB can vary greatly and may include uterine fibroids or polyps, irregular ovulation, hormonal contraception, endometrial problems, underlying bleeding disorders such as von Willebrand disease, or cancer. Isolating the cause of AUB can help in developing an appropriate treatment or management plan. 

The new recommendations address diagnosis of AUB using a thorough medical history and physical exam, appropriate laboratory and imaging tests, and considerations of age-related factors. The College also supports the adoption of the new International Federation of Gynecology and Obstetrics (FIGO) classification system for AUB to help standardize the terminology used to describe AUB in conjunction with its underlying cause, such as uterine polyps (AUB-P). 

Practice Bulletin #128 “Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women” is published in the July issue of Obstetrics & Gynecology.

Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #529 “Placenta Accreta (New!)

Abstract: Placenta accreta is a potentially life-threatening obstetric condition that requires a multidis­ciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with a placenta previa that overlies the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to mini­mize potential maternal or neonatal morbidity and mortality. Grayscale ultrasonography is sensitive enough and specific enough for the diagnosis of placenta accreta; magnetic resonance imaging may be helpful in ambiguous cases. Although recognized obstetric risk factors allow the identification of most cases during the antepartum period, the diagnosis is occasionally discovered at the time of delivery. In general, the recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associated with significant hemorrhagic morbidity. However, surgical man­agement of placenta accreta may be individualized. Although a planned delivery is the goal, a contingency plan for an emergency delivery should be developed for each patient, which may include following an institutional protocol for maternal hemorrhage management.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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