OtherEvidenced-Based Clinical Medicine

Abnormal Uterine Bleeding: A Management Algorithm

John W. Ely, Colleen M. Kennedy, Elizabeth C. Clark and Noelle C. Bowdler
The Journal of the American Board of Family Medicine November 2006, 19 (6) 590-602; DOI: https://doi.org/10.3122/jabfm.19.6.590

References

  1. ↵
    Nicholson WK, Ellison SA, Grason H, Powe NR. Patterns of ambulatory care use for gynecologic conditions: a national study. Am J Obstet Gynecol 2001; 184: 523–30.
    OpenUrlCrossRefPubMed
  2. ↵
    ACOG practice bulletin: management of anovulatory bleeding. Int J Gynaecol Obstet 2001; 72: 263–71.
    OpenUrlCrossRefPubMed
  3. ↵
    Albers JR, Hull SK, Wesley MA. Abnormal uterine bleeding. Am Fam Phys 2004; 69: 1915–26.
    OpenUrlPubMed
  4. ↵
    Goldstein SR. Menorrhagia and abnormal bleeding before the menopause. Best Pract Res Clin Obstet Gynaecol 2004; 18: 59–69.
    OpenUrlCrossRefPubMed
  5. ↵
    Farrell E. Dysfunctional uterine bleeding. Aust Fam Physician 2004; 33: 906–8.
    OpenUrlPubMed
  6. ↵
    Kilbourn CL, Richards CS. Abnormal uterine bleeding. Diagnostic considerations, management options. Postgrad Med 2001; 109: 137–8, 141–4, 147–50.
    OpenUrlPubMed
  7. ↵
    Oriel KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999; 60: 1371–80; Discussion 1381–2.
    OpenUrlPubMed
  8. ↵
    Kuppermann M, Varner RE, Summitt RL, Jr., et al. Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial. JAMA 2004; 291: 1447–55.
    OpenUrlCrossRefPubMedWeb of Science
  9. Tantiwattanakul P, Taneepanichskul S. Effect of mefenamic acid on controlling irregular uterine bleeding in DMPA users. Contraception 2004; 70: 277–9.
    OpenUrlPubMed
  10. Rauramo I, Elo I, Istre O. Long-term treatment of menorrhagia with levonorgestrel intrauterine system versus endometrial resection. Obstet Gynecol 2004; 104(6): 1314–21.
    OpenUrl
  11. Searle J, Grover S, Santin A, Weideman P. Randomised trial of an integrated educational strategy to reduce investigation rates in young women with dysfunctional uterine bleeding. Aust N Z J Obstet Gynaecol 2002; 42: 395–400.
    OpenUrlPubMed
  12. Kennedy AD, Sculpher MJ, Coulter A, et al. Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial. JAMA 2002; 288: 2701–8.
    OpenUrlCrossRefPubMedWeb of Science
  13. Istre O, Trolle B. Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection. Fertil Steril 2001; 76: 304–9.
    OpenUrlCrossRefPubMedWeb of Science
  14. Cooper KG, Jack SA, Parkin DE, Grant AM. Five-year follow up of women randomised to medical management or transcervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes. BJOG 2001; 108: 1222–8.
    OpenUrlPubMed
  15. ↵
    Working Party for Guidelines for the Management of Heavy Menstrual Bleeding. An evidence-based guideline for the management of heavy menstrual bleeding. N Z Med J 1999; 112: 174–7.
    OpenUrlPubMedWeb of Science
  16. ↵
    Bongers MY, Mol BW, Brolmann HA. Current treatment of dysfunctional uterine bleeding. Maturitas 2004; 47: 159–74.
    OpenUrlCrossRefPubMedWeb of Science
  17. ↵
    Tscherne G. Menstrual irregularities. Evidence-based clinical practice. Endocr Dev 2004; 7: 129–39.
    OpenUrlPubMed
  18. ↵
    Buckingham K, Fawdry A, Fothergill D. Management of vaginal bleeding presenting to the accident and emergency department. J Accid Emerg Med 1999; 16: 130–5.
    OpenUrlFREE Full Text
  19. Iglesias EA, Coupey SM. Menstrual cycle abnormalities: diagnosis and management. Adolesc Med 1999; 10: 255–73.
    OpenUrlPubMed
  20. Minjarez DA, Bradshaw KD. Abnormal uterine bleeding in adolescents. Obstet Gynecol Clin North Am 2000; 27: 63–78.
    OpenUrlPubMed
  21. ↵
    Minjarez DA. Abnormal bleeding in adolescents. Semin Reprod Med 2003; 21: 363–73.
    OpenUrlPubMed
  22. ↵
    Neale EJ, Chang AM. Clinical algorithms. Med Teach 1991; 13: 317–22.
    OpenUrlPubMed
  23. Sadler C. Pitfalls in the use of clinical algorithms. Ortho Clin North Am 1986; 17: 545–547.
    OpenUrlPubMed
  24. Fred HL. Algorithms: let’s give them back. Hosp Pract (Off Ed) 2000; 35: 15–6.
    OpenUrlPubMed
  25. ↵
    Kassirer JP, Kopelman RI. Diagnosis and decisions by algorithms. Hosp Pract (Off Ed) 1990; 25: 23–4, 27, 31.
    OpenUrlPubMed
  26. ↵
    McDonald CJ, Wilson GA, McCabe GP, Jr. Physician response to computer reminders. JAMA 1980; 244: 1579–81.
    OpenUrlCrossRefPubMedWeb of Science
  27. ↵
    Shoemaker WC, Corley RD, Liu M, et al. Development and testing of a decision tree for blunt trauma. Crit Care Med 1988; 16: 1199–208.
    OpenUrlPubMed
  28. Wirtschafter DD, Sumners J, Jackson JR, Brooks CM, Turner M. Continuing medical education using clinical algorithms: a controlled trial assessment of effect on neonatal care. Am J Dis Child 1986; 140: 791–7.
    OpenUrlCrossRefPubMed
  29. ↵
    Margolis CZ, Cook CD, Barak N, Adler A, Geertsma A. Clinical algorithms teach pediatric decision making more effectively than prose. Med Care 1989; 27: 576–92.
    OpenUrlCrossRefPubMedWeb of Science
  30. ↵
    Margolis CZ. Pediatric algorithms. J Pediatr 1987; 110: 417–8.
    OpenUrlPubMed
  31. ↵
    Feinstein AR. An analysis of diagnostic reasoning: III. The construction of clinical algorithms. Yale J Biol Med 1974; 1: 5–32.
    OpenUrl
  32. ↵
    Horabin I, Lewis BN. Algorithms. Englewood Cliffs (NJ): Educational Technology Publications; 1978.
  33. ↵
    Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 7th ed. Baltimore: Lippincott Williams & Wilkins; 2004.
  34. ↵
    Epstein E, Valentin L. Managing women with post-menopausal bleeding. Best Pract Res Clin Obstet Gynaecol 2004; 18: 125–43.
    OpenUrlCrossRefPubMed
  35. ↵
    James A, Matchar DB, Myers ER. Testing for von Willebrand disease in women with menorrhagia: a systematic review. Obstet Gynecol 2004; 104: 381–8.
    OpenUrlPubMed
  36. ↵
    Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic review. BJOG 2004; 111: 734–40.
    OpenUrlPubMed
  37. ↵
    Dijkhuizen FP, Mol BW, Bongers MY, Brolmann HA, Heintz AP. Cost-effectiveness of transvaginal sonography and saline infused sonography in the evaluation of menorrhagia. Int J Gynaecol Obstet. 2003; 83: 45–52.
    OpenUrlCrossRefPubMed
  38. ↵
    Turner RT, Berman AM, Topel HC. Improved demonstration of endometrial polyps and submucous myomas using saline-enhanced vaginal sonohysterography. J Am Assoc Gynecol Laparosc 1995; 2: 421–5.
    OpenUrlCrossRefPubMedWeb of Science
  39. ↵
    Mitan LA, Slap GB. Adolescent menstrual disorders. Update. Med Clin North Am 2000; 84: 851–68.
    OpenUrlCrossRefPubMed
  40. ↵
    Strickland JL, Wall JW. Abnormal uterine bleeding in adolescents. Obstet Gynecol Clin North Am 2003; 30: 321–35.
    OpenUrlCrossRefPubMedWeb of Science
  41. ↵
    Kaunitz AM. Gynecologic problems of the perimenopause: evaluation and treatment. Obstet Gynecol Clin North Am 2002; 29: 455–73.
    OpenUrlPubMed
  42. ↵
    Weiss G. Menstrual irregularities and the perimenopause. J Soc Gynecol Investig 2001; 8(1 Suppl Proceedings): S65–6.
    OpenUrl
  43. ↵
    Field CS. Dysfunctional uterine bleeding. Prim Care 1988; 15: 561–74.
    OpenUrlPubMed
  44. ↵
    Crosignani PG, Vegetti W. A practical guide to the diagnosis and management of amenorrhoea. Drugs 1996; 52: 671–81.
    OpenUrlPubMed
  45. ↵
    Wathen PI, Henderson MC, Witz CA. Abnormal uterine bleeding. Med Clin North Am 1995; 79: 329–44.
    OpenUrlPubMedWeb of Science
  46. ↵
    Chen KT. Acute and chronic endometritis. Available from: UpToDate.com. Accessed on March 25, 2006.
  47. ↵
    Michels TC. Chronic endometritis. Am Fam Physician 1995; 52: 217–22.
    OpenUrlPubMed
  48. ↵
    Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175(3 Pt 2): 766–9.
    OpenUrl
  49. ↵
    Gordon CM. Menstrual disorders in adolescents. Excess androgens and the polycystic ovary syndrome. Pediatr Clin North Am 1999; 46: 519–43.
    OpenUrlCrossRefPubMedWeb of Science
  50. ↵
    Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41–7.
    OpenUrlAbstract/FREE Full Text
  51. ↵
    Barbieri RL, Ehrmann DA. Diagnosis and treatment of polycystic ovary syndrome in adults. Available from: UpToDate.com. Accessed on March 25, 2006.
  52. ↵
    Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril 2005; 84: 682–6.
    OpenUrlCrossRefPubMedWeb of Science
  53. ↵
    Valenzano MM, Lijoi D, Mistrangelo E, Fortunato T, Costantini S, Ragni N. The value of sonohysterography in detecting intracavitary benign abnormalities. Arch Gynecol Obstet 2005; 272: 265–8. Epub 2005 Oct 13.
    OpenUrlPubMed
  54. ↵
    Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol 1997; 177: 102–8.
    OpenUrlCrossRefPubMed
  55. ↵
    Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 2004; 190: 1216–23.
    OpenUrlCrossRefPubMedWeb of Science
  56. ↵
    Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril 2005; 84: 1345–51.
    OpenUrlCrossRefPubMed
  57. Kujovich JL. von Willebrand’s disease and menorrhagia: prevalence, diagnosis, and management. Am J Hematol 2005; 79: 220–8.
    OpenUrlCrossRefPubMedWeb of Science
  58. ↵
    Philipp CS, Miller CH, Faiz A, et al. Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time. Haemophilia 2005; 11: 497–503.
    OpenUrlPubMed
  59. ↵
    Hurskainen R, Teperi J, Rissanen P, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA 2004; 291: 1456–63.
    OpenUrlCrossRefPubMedWeb of Science
  60. ↵
    Grover V, Usha R, Gupta U, Kalra S. Management of cyclical menorrhagia with prostaglandin synthetase inhibitor. Asia Oceania J Obstet Gynaecol 1990; 16: 255–9.
    OpenUrlPubMed
  61. ↵
    Fraser IS, McCarron G. Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Aust N Z J Obstet Gynaecol 1991; 31: 66–70.
    OpenUrlPubMedWeb of Science
  62. ↵
    Rosenfeld JA. Treatment of menorrhagia due to dysfunctional uterine bleeding. Am Fam Physician 1996; 53: 165–72.
    OpenUrlPubMed
  63. ↵
    Rees M. Menorrhagia. Br Med J (Clin Res Ed) 1987; 294: 759–62.
    OpenUrlPubMed
  64. ↵
    Bulusu S. Secondary amenorrhoea J R Soc Med 1996; 89: 220P–1P.
    OpenUrlPubMed
  65. Aloi JA. Evaluation of amenorrhea. Compr Ther 1995; 21: 575–8.
    OpenUrlPubMed
  66. Burnett RG. Diagnostic strategies for amenorrhea. Postgrad Med 1990; 87: 241–7, 250.
    OpenUrlPubMed
  67. ↵
    Franks S. Primary and secondary amenorrhoea. Br Med J (Clin Res Ed) 1987; 294: 815–9.
    OpenUrlPubMed
  68. ↵
    Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA 1993; 269: 1823–8.
    OpenUrlCrossRefPubMedWeb of Science
  69. Rowland AS, Baird DD, Long S, et al. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology 2002; 13: 668–74.
    OpenUrlCrossRefPubMedWeb of Science
  70. Weeks AD. Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia BMJ 2000; 320: 649.
    OpenUrlFREE Full Text
  71. Krassas GE, Pontikides N, Kaltsas T, et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol (Oxf) 1999; 50: 655–9.
    OpenUrlCrossRefPubMed
  72. Koutras DA. Disturbances of menstruation in thyroid disease. Ann N Y Acad Sci 1997; 816: 280–4.
    OpenUrlPubMedWeb of Science
  73. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Batrinos M. Menstrual disturbances in thyrotoxicosis. Clin Endocrinol (Oxf) 1994; 40: 641–4.
    OpenUrlPubMed
  75. Farhi DC, Nosanchuk J, Silverberg SG. Endometrial adenocarcinoma in women under 25 years of age. Obstet Gynecol 1986; 68: 741–5.
    OpenUrlPubMedWeb of Science
  76. Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound 2004; 32: 348–53.
    OpenUrlCrossRefPubMed
  77. Learman LA, Summitt RL Jr., Varner RE, et al. Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial. Obstet Gynecol 2004; 103(5 Pt 1): 824–33.
    OpenUrl
  78. Hurskainen R, Teperi J, Rissanen P, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA 2004; 291: 1456–63.
    OpenUrlCrossRefPubMedWeb of Science
  79. Lahteenmaki P, Haukkamaa M, Puolakka J, et al. Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. BMJ 1998; 316: 1122–6.
    OpenUrlAbstract/FREE Full Text
  80. ↵
    Ebell MH, Siwek J, Weiss BD. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. J Fam Pract 2004; 53: 111–20.
    OpenUrlPubMedWeb of Science
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