FEATURES OF CLINICAL PRESENTATION OF ABNORMAL UTERINE BLEEDING IN WOMEN OF REPRODUCTIVE AGE

Abstract

Abnormal uterine bleeding (AUB) is an urgent clinical problem that has not been fully studied at this stage. AUB affects the quality of life, causes reproductive losses, and requires significant health care costs. The purpose of the study is to outline and generalize the basic principles of diagnosis and presentation of AUB in women of reproductive age based on literature analysis and international recommendations. A literature review of world citation databases (MEDLINE, EMBASE, Cochrane) over the last 10 years was conducted. The concept of a normal menstrual cycle and AUB is defined. The classification of the International Federation of Gynecology and Obstetrics is presented. The main pathological conditions resulting in AUB have been determined. To choose a rational strategy for patient management, it is necessary to establish the cause of AUB and assign it to one of the categories according to the PALM-COEIN classification. PALM-COEIN classification distinguishes two main groups of AUB, related and not related to organic disorders of the uterus. A morphologic cause (PALM) can be diagnosed by imaging and/or histology, while the COEIN group is associated with causes that cannot be visualized (non-morphologic). According to international recommendations, laboratory diagnosis of patients with AUB involves certain stages: determination of the level of β-HCG in blood serum; examination for the presence of anemia; determination of the coagulogram. Hormonal examination is carried out in case of irregular menstrual rhythm and risk of hypothyroidism; tests on chlamydial infection (in case of high infection risk); a Pap test is performed to rule out cervical diseases. Hysteroscopy and endometrial biopsy are considered the “gold standard” for the diagnosis of intrauterine abnormalities, primarily to exclude precancerous lesions and endometrial cancer

Keywords

• abnormal uterine bleeding,menstrual cycle,morphological and non-morphological causes,intrauterine abnormalities