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Semin Reprod Med 2011; 29(5): 410-422
DOI: 10.1055/s-0031-1287665
© Thieme Medical Publishers

The Need for Investigations to Elucidate Causes and Effects of Abnormal Uterine Bleeding

Malcolm G. Munro1 , Oskari Heikinheimo2 , Rohana Haththotuwa3 , Jaydeep D. Tank4 , Ian S. Fraser5
  • 1Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
  • 2Department of Obstetrics and Gynaecology, University of Helsinki, Finland
  • 3Ninewells CARE Mother & Baby Hospital, Colombo, Sri Lanka
  • 4Ashwini Maternity and Surgical Hospital, Center for Advanced Endoscopy, Assisted Reproduction and In Vitro Fertilization (IVF), Mumbai, India
  • 5Department of Obstetrics and Gynaecology, University of Sydney, Australia
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Publication Date:
07 November 2011 (online)

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ABSTRACT

This article describes a modern perspective on the basic investigations for abnormal uterine bleeding (AUB) in low-resource settings compared with a much more detailed approach for high-resource settings, bearing in mind issues of effectiveness and cost effectiveness. AUB includes any one or more of several symptoms, and it should be evaluated for the characteristics of the woman's specific bleeding pattern, her “complaint” and the presence of other symptoms (especially pain), the impact on several aspects of body functioning and lifestyle, and the underlying cause(s), especially cancer. Ideally, the evaluation is comprehensive, considering each of the potential etiological domains defined by the International Federation of Gynecology and Obstetrics PALM-COEIN system for the classification of causes. However, the detail of the questions and the extent of investigations will be significantly influenced by the technologies available and the time allotted for a consultation. In general, investigations should be performed only if they will make a material difference to the management approaches that can be offered. This should be an important consideration when a range of costly high-technology tests is accessible or when certain tests only have limited availability.

KEYWORDS

Abnormal uterine bleeding - heavy bleeding - investigations - imaging

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Malcolm G MunroM.D. 

Department of Obstetrics and Gynaecology, David Geffen School of Medicine at UCLA, Kaiser Permanente, Los Angeles Medical Center

Station 3-B, 4900 Sunset Boulevard, Los Angeles, CA 90027

Email: mmunro@ucla.edu