Resolution of the II Ukrainian forum of experts on abnormal uterine bleeding

Abstract

Approaches to the diagnosis and treatment of abnormal uterine bleeding (AUB) are constantly updated due to the new results of clinical studies and in the process of revising international clinical guidelines. These updates need to be implemented in clinical practice. Therefore, on October 20, 2023, the II Ukrainian Forum of experts on AUB was held, the key provisions of which are outlined in this resolution. A new multi-level three-component classification system «HyPO-P + GAIN-FIT-PIE» developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022 was presented at the Forum. FIGO experts anatomically grouped the causes of ovulation disorders into 4 groups: I – hypothalamic, II – pituitary, III – ovarian, IV – polycystic ovary syndrome (first level HyPO-P). Also, this classification system includes the second level GAIN-FIT-PIE (genetic, autoimmune, iatrogenic, neoplastic; functional, infectious, inflammatory, traumatic, vascular; physiological, idiopathic, endocrine) and the third level with examples of specific conditions within the subgroups of the second level. Correct classification of ovulation disorders is important for the AUB diagnosis and management, since ovulation disorders are associated with disorders of the menstrual cycle characteristics, which leads to the development of functional AUB. In order to optimize the treatment of patients with AUB, the experts of the Forum developed an algorithm for the AUB management taking into account the individual approach and characteristics of the patient, which is based on the current FIGO classifications – PALM-COEIN (2018) and HyPO-P + GAIN-FIT-PIE (2022). According to this algorithm, patient management tactics depend on the type of disorders (structural, functional), the patient’s reproductive stage (adolescence, active reproductive age, perimenopause) and the need for contraception. Hormonal drugs (combined oral contraceptives and progestogens) are main direction of pharmacotherapy of functional AUB. The high efficiency of dydrogesterone among the progestogens has been proven, starting from the first cycle of therapy.

Keywords

• abnormal uterine bleeding
• ii ukrainian forum of experts on abnormal uterine bleeding
• resolution