Recommendations:
- 1. Adoption of standardized international terminology for abnormal uterine bleeding should be considered (III-C).
- 2. A complete blood count is recommended for women with heavy or prolonged bleeding (II-2A).
- 3. If there is any possibility of pregnancy, a sensitive urine or serum pregnancy test should be performed (III-C).
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- 4.Testing for coagulation disorders should be considered only in women
who have a history of heavy menstrual bleeding beginning at menarche or who have a personal or family history of abnormal bleeding(II-2B).
- 5.Thyroid function tests are not indicated unless there are clinical findIngs suggestive of and index of possible suspicions of thyroid disease(II-2D).
- 6. Transvaginal ultrasound should be the first line imaging modality for abnormal uterine bleeding (I-A).
- 7. SIS and diagnostic hysteroscopy should be used in the diagnosis and characterization of discrete intrauterine abnormalities such as submucosal fibroids (I-A).
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- 8-Endometrial biopsy should be considered in bleeding women over
age 40 or in those with bleeding not responsive to medical therapy, as well as in younger women with risk factors from endometrial cancer(II-2A).
- 9 - Office endometrial biopsy should replace dilation and uterine curettage
as the initial assessment of the endometrium for these women (II-2A).
- 10. Focal lesions of the endometrium that require biopsy should be managed through hysteroscopy-guided evaluation (II-2A).
- 11. Non-hormonal options such as NSAI drugs and antifibrinolytics can be used effectively to treat heavy menstrual bleeding that is mainly cyclic or predictable in timing(I-A).
- 12.Coc pills, depot medroxyprogesterone acetate, and levonorgestrel-releasing intrauterine systems significantly reduce menstrual bleeding and should be used to treat women with AUB who desire effective contraception(I-A).
- 13. Cyclic luteal-phase progestins do not effectively reduce blood loss and therefore should not be used as a specific treatment for heavy menstrual bleeding (I-E).
- 14. Danazol and gonadotropin-releasing hormone agonists will effectively reduce menstrual bleeding, and may be used for scenarios in which other medical or surgical treatments have failed or are contraindicated(I-C).
- 15. Patients receiving a gonadotropin-releasing hormone agonist for longer than 6 months should be prescribed add-back hormone therapy, if not already initiated with gonadotropin-releasing hormone agonist commencement (I-A).
- 16. The progestin intrauterine system has outcomes similar to endometrial ablation for women with heavy menstrual bleeding and thus may be considered prior to surgical intervention (I-A).
- 17. In appropriate candidates, non-hysteroscopic ablation techniques should be the ablation methods of choice in view of their higher efficacy and safety than hysteroscopic techniques (I-A).
- 18. With the exception of non-steroidal anti-inflammatory drugs, the same medical agents used to treat heavy menstrual bleeding among women with normal coagulation can effectively be used in the setting of inherited bleeding disorders (II-1B).
- 19. Hysterectomy planning or blood product therapy should be performed in consultation with a hematologist in patients with inherited bleeding disorders (III-C).
- 20. High-dose estrogen and tranexamic acid may help decrease or arrest acute heavy menstrual bleeding (III-C).
- 21. For the adolescent presenting with heavy menstrual bleeding at or in close approximation to menarche, history and investigations should include an assessment for an underlying bleeding disorder (II-2A).