An International Response to Questions about Terminologies, Investigation, and Management of Abnormal Uterine Bleeding: Use of an Electronic Audience Response System

ABSTRACT

More than 600 registrants attended a two-hour interactive symposium on abnormal uterine bleeding (AUB) at the Federation of Gynecology and Obstetrics World Congress in Cape Town, October 2009. Nearly 250 of these participants answered multiple questions through an electronic audience responder system. The audience heard five structured presentations on clinically important and controversial aspects of AUB, including terminologies and definitions, classification of causes, mechanisms of AUB in the absence of structural lesions of the reproductive tract, the potential for a structured menstrual history, and management of heavy menstrual bleeding (HMB) in low-resource settings. Numerous demographic details were collected, and a total of 30 questions to the audience were interspersed through each of the presentations. The audience demonstrated great variation in the way the terms AUB, menorrhagia, and dysfunctional uterine bleeding (DUB) are used, and considerable majorities agreed that the terms menorrhagia and DUB should be abolished. AUB should be the overarching term to describe all symptomatic departures from normal menstruation or the menstrual cycle. HMB is a suitable replacement term for menorrhagia. DUB can be replaced by the three clinical entities comprising “nonstructural” causes of AUB. There was a high consistency across demographic subgroups in answers to most questions. Acute and chronic AUB were defined, and aspects of a classification system for causes of AUB and of a structured menstrual history were explored. Issues related to investigation and hormonal treatment of HMB in low-resource settings were explored by registrants from developing countries.

KEYWORDS

Abnormal uterine bleeding - terminologies - investigation - management - menorrhagia - FIGO classification

REFERENCES

• 1 Woolcock J G, Critchley H O, Munro M G, Broder M S, Fraser I S. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding.  Fertil Steril. 2008;  90 (6) 2269-2280
• 2 Fraser I S, Critchley H O, Munro M G, Broder M. Writing Group for this 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 Fraser I S, Critchley H O, Munro M G, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding?.  Hum Reprod. 2007;  22 (3) 635-643
• 4 Fraser I S, Critchley H O, Broder M, Munro M G. The FIGO recommendation on terminologies and definitions for normal and abnormal uterine bleeding.  Sem Reprod Med. 2011;  29 (5) 383-390
• 5 Munro MG, Heikinheimo O, Haththotuwa R, Tank J, Fraser I S. The need for investigations to elucidate causes and effects of abnormal uterine bleeding.  Semin Reprod Med. 2011;  29 (5) 410-422
• 6 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) 485-489
• 7 Kouides P A, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding.  Fertil Steril. 2005;  84 (5) 1345-1351
• 8 Shankar M, Lee C A, Sabin C A, Economides D L, Kadir R A. von Willebrand disease in women with menorrhagia: a systematic review.  BJOG. 2004;  111 (7) 734-740
• 9 Matteson K, Munro M G, Fraser I S. The structured menstrual history: developing a tool to facilitate diagnosis and aid in symptom management.  Semin Reprod Med. 2011;  29 (5) 423-435
• 10 Haththotuwa R, Desai S, Senanayake L, Goonewardena J, Tank J, Fraser I S. Management of abnormal uterine bleeding in low- and high-resource settings: consideration of cultural issues.  Semin Reprod Med. 2011;  29 (5) 446-458