Therapeutic tactics in abnormal uterine bleeding without anatomical substrate
https://doi.org/10.21518/2079-701X-2018-21-168-172
Abstract
The purpose of the review: presentation of modern data on the pathogenesis of abnormal uterine bleeding (AMC) without anatomical substrate (ovulatory, endometrial, coagulopathic) and the effectiveness of their treatment with medication.
Basic provisions. Information on the pathogenesis of AMC not associated with structural abnormalities of the uterus is presented. It was shown that non-hormonal drugs have similar efficacy. Among the hormonal agents, levonorgestrel-containing intrauterine system (IUD-LNG) and estrogen-progestogen preparations (combined oral contraceptives, COCs) favorably differ. COCs recover an acute episode of AMC in 66.8% of cases (according to some data – in 88%), which is higher in comparison with non-hormonal drugs; in chronic cases – reduce blood loss by 88% (after 6 months of therapy), and are not inferior in effectiveness to intrauterine devices with levonorgestrel (83% after 3 months of therapy).
The conclusion. Thus, non-hormonal drugs have similar efficacy in arresting AMC without an anatomical substrate, but are inferior to COCs. In case of chronic AMC, the first-line drugs are IUD-LNG and COC containing E2B / NNG, which contribute to the normalization of the menstrual cycle and the volume of menstrual blood loss with proven efficacy.
About the Author
G. В. Dikke
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Galina B. Dikke – Honored Scientist and Education Worker, MD, Professor of the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Advanced Training of Medical Workers
Moscow, 117198, Maclay st., 6
References
1. Fraser I.S., Critchley H.O., Broder M., Munro M.G. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011; 29(5): 383-90.
2. Management of acute abnormal uterine bleeding in nonpregnant reproductive aged women. American College of Obstetricians and Gynecologists. Committee Opinion No. 557. Obstet Gynecol. 2013; 121(4): 891-896.
3. Matteson K.A., Abed H., Wheeler T.L., Sung V.W. et al. A systematic review comparing hysterectomy with less-invasive treatments for abnormal uterine bleeding. J Minim Invasive Gynecol. 2012; 19(1): 13–28.
4. Munro M.G., Critchley H.O., Broder M.S., Fraser I.S. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. FIGO Working Group on Menstrual Disorders. Int J Gynaecol Obstet. 2011; 113(3): 3-13.
5. National Collaborating Centre for Women’s and Children’s Health, National Institute of Clinical Excellence. Heavy menstrual bleeding. Clinical guideline 44. London: RCOG Press; 2007. UpDate 2018. Available at: http://www.nice.org.uk.
6. Ferin M. The Hypothalamic-HypophysealOvarian Axis and the Menstrual Cycle. Glob. libr. women’s med. 2008 (ISSN: 1756-2228) [web] [viewed 31 August 2014] Available from: http://www.glowm.com.
7. Kadir R.A., Economides D.L., Sabin C.A., Owens D., Lee C.A. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998; 351(9101): 485-9.
8. Munro M.G. Abnormal Uterine Bleeding. Cambridge University Press. 2010:978-0-521-72183-7.
9. Kolev К, Longstaff С. Bleeding related to disturbed fibrinolysis. Br J Haematol. 2016; 175(1): 12–23.
10. Toth M., Patton D.L., Esquenazi B., Shevchuk M., Thaler H., Divon M. Association between Chlamydia trachomatis and abnormal uterine bleeding. Am J Reprod Immunol. 2007; 57(5): 361-6.
11. Bradley L.D., Gueye N.A. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016; 214(1): 31-44.
12. Lethaby A., Farquhar C., Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2000, Issue 4. Art. No.: CD000249. DOI: 10.1002/14651858.CD000249.
13. DeVore G.R., Owens O., Kase N. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding—a double-blind randomized control study. Obstet Gynecol. 1982; 59: 285-91.
14. Munro M.G., Mainor N., Basu R., Brisinger M., Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006; 108(4): 924–9.
15. Fraser I.S., Parke S., Mellinger U., Machlitt A. et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011; 16(4): 258–269.
16. Jensen J.T., Parke S., Mellinger U., Machlitt A. et al. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet. Gynecol. 2011; 117(4): 777–787.
17. Farquhar C., Brown J. Oral contraceptive pill for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009, Issue 7(4). Art. No.:CD000154.
18. Lethaby A., Duckitt K., Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013, Issue 1. Art. No.: CD000400.
19. Lethaby A., Irvine G.A., Cameron I.T. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2008, Issue 1. Art. No.: CD001016.
20. Kadir R.A., Lukes A.S., Kouides P.A., Fernandez H., Goudemand J. Management of excessive menstrual bleeding in women with hemostatic disorders. Fertil Steril. 2005; 84: 1352-1359.
21. Lethaby A., Hussain M., Rishworth J.R., Rees M.C. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2015, Issue 4. Art. No.: CD002126.
22. Leminen H., Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health. 2012; 4: 413-421.
23. Shabaan M.M. et al. Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: A randomized clinical trial. Contraception. 2011 Jan; 83: 48.
24. Jensen J.T., Parke S., Mellinger U., Machlitt A., Fraser I.S. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol. 2011; 117: 777–87.
25. Abu Hashim H., Alsherbini W., Bazeed M. Contraceptive vaginal ring treatment of heavy menstrual bleeding: a randomized controlled trial with norethisterone. Contraception. 2012; 85: 246–252.
26. Ahrendt H.J., Makalova D., Parke S., Mellinger U., Mansour D. Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinyl estradiol/levonorgestrel. Contraception. 2009; 80(5): 436–44.
27. National Collaborating Centre for Women’s and Children’s Health Heavy menstrual bleeding [NICE clinical guideline 44]. London (UK): National Institute for Health and Clinical Excellence, 2016. Access mode: https://www.nice.org.uk/.
28. ACOG practice bulletin no. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010;115:206–218.
29. Menopausal hormone therapy and the preservation of the mature age women’s health. Clinical guidelines (treatment protocol). M., 2015. 49 p. (In Russ).
30. Grandi G., Napolitano A., Cagnacci A. Metabolic impact of combined hormonal contraceptives containing estradiol. Expert Opin Drug Metab Toxicol. 2016; 12: 779-787.
31. Sitruk-Ware R., Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Pract Res Clin Endocrinol Metab. 2013; 27: 13–24.
32. Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005; 8(Suppl 1): 3–63.
33. Dinger J., Minhb T.D., Heinemann K. Impact of estrogen type on cardiovascular safety of combined oral contraceptives. Contraception. 2016; 94: 328–39.
34. Lethaby A., Irvine G., Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst. Rev. 2008; (1) CD001016.
35. Maybin J.A., Critchley H.O.D. Medical management of heavy menstrual bleeding. Womens Health (Lond). 2016; 12(1): 27–34.
36. Malik S., Day K., Perrault I., Charnock-Jones D.S., Smith S.K. Reduced levels of VEGF-A and MMP-2 and MMP-9 activity and increased TNFalpha in menstrual endometrium and effluent in women with menorrhagia. Hum. Reprod. 2006; 21(8): 2158–2166.
37. Smith O.P., Jabbour H.N., Critchley H.O. Cyclooxygenase enzyme expression and E series prostaglandin receptor signalling are enhanced in heavy menstruation. Hum. Reprod. 2007; 22(5): 1450–1456.
Review
For citations:
Dikke GВ. Therapeutic tactics in abnormal uterine bleeding without anatomical substrate. Meditsinskiy sovet = Medical Council. 2018;(21):168-172. (In Russ.) https://doi.org/10.21518/2079-701X-2018-21-168-172
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