An analytical study of abnormal uterine bleeding in women of child bearing age group

  • Dr. Radhika Parmar
  • Dr. Aditi Atodaria
  • Dr. Tulsi Patel
  • Dr. Kishor Chauhan
Keywords: .

Abstract

AUB is defined as any variation from the normal menstrual cycle. It includes alteration in its frequency, regularity of menses, duration of flow and amount of blood loss AUB can further be divided based on regularity, volume, frequency, duration, chronicity and timing in relation to the reproductive status.

In India, the reported prevalence of AUB is 17.9%. It can occur any time between menarche to menopause.

A good clinician tries to recognize and identify the causative factors responsible for the disease, reverse the abnormality and induce or restore the cyclic predictable menses which should have normal volume and duration.

MATERIALS AND METHOD

SOURCE OF DATA: 200 cases of AUB were taken for our study from the Department of Obstetrics and Gynecology, in our institute between November 2017 to May 2019. Patients coming in the O.P.D. or the ones that were admitted in the Gynecology ward for the complaints of AUB, fitting the selection criteria were included in the study.

SELECTION CRITERIA:

INCLUSION CRITERIA:

Women aged 15-45 yrs.

Cases of Abnormal uterine bleeding, attending the gynecology OPD with complaints of heavy menstrual bleeding, heavy and frequent bleeding, frequent bleeding, infrequent bleeding

EXCLUSION CRITERIA:

Pregnancy and related complications. Women with normal menstrual cycles

Women taking drugs like anticoagulants, glucocorticoids or tamoxifen, which can cause abnormal uterine bleeding

Women with Pelvic inflammatory diseases Women who have IUD inserted.

RESULT AND DISCUSSION:

After applying the inclusion and exclusion criteria, 200 cases were selected for my study. A/B is more common in the age group 41-45 years, suggesting it is more towards the perimenopausal age group. It is seen more in multiparous women and women with previous surgeries on uterus and adnexa. Heavy Menstrual Bleeding is the most common complaint. Endometrial Hyperplasia was the most common finding on ultrasound examination. Medical therapy was beneficial in some patients, rest had to undergo surgical intervention later. Hysterectomy is used as a final measure. Vaginal Hysterectomy is preferred.

CONCLUSION:

It is observed that AUB is more common towards the end of 4th decade of life, in the peri-menopausal age group, that too more in multiparous women. Surgical intervention on the uterus and adnexa are also associated with AUB.Heavy Menstrual Bleeding is the most common presenting complaint. Clinical examination correlates well with the ultrasound findings, however, transvaginal sonography is very accurate in assessing the endometrium as well as uterus and adnexa and diagnosing their abnormalities.

Medical Therapy is still the first line of management in most cases which includes progestogens, combined oral contraceptive pills or a combination of tranexamic acid and mefenamic acid.

Dilatation and Curettage still holds a role in diagnosis and has therapeutic effect as well. But should be used along with hysteroscopy for better results. LNG-IUS gives very good result in suitable cases.

Hysterectomy is the final measure if everything else fails. Vaginal hysterectomy is preferred wherever possible.

Author Biographies

Dr. Radhika Parmar

M.D (Obstetrics and gynecology ), AssociProfessor, Department of obstetrics and gynecology , Smt.B.K.Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be university, waghodia, Vadodara. District 391760, Contribution: Concept, Planning, Literature review, Manuscript preparation.

Dr. Aditi Atodaria

second year Resident doctor (obstetrics and gynecology) , Department of obstetrics and gynecology, Smt.B.K.Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be university, waghodia, Vadodara. District 391760, Contribution: Data Collection.

Dr. Tulsi Patel

Second year Resident doctor (obstetrics and gynecology) , Department of obstetrics and gynecology, Smt.B.K.Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be university, waghodia, Vadodara. District 391760,  Contribution: Data Collection.

Dr. Kishor Chauhan

M.D (Obstetrics and gynecology ), Professor and head of Department, Department of obstetrics and gynecology , Smt.B.K.Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth Deemed to be university, waghodia, Vadodara. District 391760,  Contribution: Literature review and Data Collection.

References

1. Munro MG. Abnormal uterine bleeding. Cambridge: Cambridge University Press; 2010.
2. Fraser IS, Langham S. Uhi-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol.2009;4:179-89.
3. Sharma A. Dogra Y. Trends of AUB in tertiary center of Shimla hills. J Midlife Health 2013;4:67-68
4. National Collaborating Centre for Women's and Children's Health, National Institute for Health and Care Excellence. NICE guidelines CG44: heavy menstrual bleeding London: Royal College of Obstetricians and Gynaecologists, 2007.
5. Jeffcoate's principles of Gynaecology 8" Edition Chapter 38 Page 560.
6. Jeffcoate's principles of Gynaecology 8th Edition Chapter 38 Page 566.
7. Progress 16th Alexander Taylor, Management of DUB
8. Cochrane database of systematic reviews 2005.
9. Jeffcoate's principles of Gynaecology 8th Edition Chapter 4 Page 72
10. Widmaier, Eric P.; Raff, Hershel; Strang, Kevin T. (2010). Vander's Human
11. Physiology: The Mechanism of Body Function (12th ed.). New York, NY: McGrawHill. pp. 555-631
12. Silverthorn, DeeUnglaub (2013). Human Physiology: An Integrated Approach (6th ed.). Glenview, IL: Pearson Education, Inc. pp. 850-890
13. Mark A Fritz and Leon speroff/clinical gynaecology endocrinology and fertility/8th edition/15th chapter/pg 593.
14. Munster K, Schmidt L, Helm P. Length and variation in the menstrual cycle a cross-sectional study from a Danish county, BJOG: An International Journal of Obstetrics and Gynaecology, 99(5), 422-429.
15. Belsey EM, Pinol APY, and Task Forceon Long-Acting Systemic Agents for Fertility Regulation, Menstrual bleeding patterns inuntreated women, Contraception 55:57, 1997.
16. Treloar AE, Boynton RE, Behn BG, Brown BW, Variation of thehuman menstrual cycle through reproductive life, Int J Fertil12:77,

Bibliography
1. Fraser IS. Critchley HOD, Munro MG, Broder M, Writing Group for this
2. Menstrual Agreement Process. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril 2007:87(3):466-476
3. Mark A Fritz and Leon speroff clinical gynaecology endocrinology and fertility/8th edition/15th chapter/pg 595
4. Munro MG. Critchley HO, Border MS, Fraser IS, FIGO Working Group on menstrual disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obset 2011;113:313.
5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists number 34, February 2002. Management of infertility caused by Gynecol. 2002, 99: (2): 347-358.
6. Jeffcoate's principles of Gynaecology 8th Edition Chapter 4 Page 80.
7. Telinde's operative gynecology/10th edition/26th chapter/pg 589.
8. Mark A Fritz and Leon speroff/clinical gynaecology endocrinology and fertility/8th edition/15th chapter/pg 593.
9. Jeffcoate's principals of gynaecology/8th edition/chapter 38/pg 566-567.
10. Mark A Fritz and Leon speroff/clinical gynaecology endocrinology and fertility/8th edition/17th chapter/pg 681.
11. National Center for Complementary and Alternative Medicine. Menopausal Symptoms and Complementary Health Practices Accessed 1/16/2015.
12. Pekker, M.and profile, V. my complete (2013) Indian women and menopause. Available at: http://menopause-aid.blogspot.in/2013/07/indian- women-andmenopause.html (Accessed: 11 January 2017).
13. Vollman RF. The Menstrual Cycle. Philadelphia, PA: W.B. Saunders; 1977
14. Soules MR, Sherman S, Parrott E, et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Climacteric 2001;4:267-272
15. NICE quality standards. http://www.nice.org.uk/guidance/QS47 Heavy menstrual bleeding.
16. Vercellini P, Cortesi 1, Oldandi S, Moschetta M, DeGiorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic
Published
2024-09-30
How to Cite
Dr. Radhika Parmar, Dr. Aditi Atodaria, Dr. Tulsi Patel, & Dr. Kishor Chauhan. (2024). An analytical study of abnormal uterine bleeding in women of child bearing age group. Revista Electronica De Veterinaria, 25(1S), 1570-1578. https://doi.org/10.69980/redvet.v25i1S.1329