Classification of menstrual bleeding disorders.

There exists a spectrum of potential causes of abnormal uterine bleeding (AUB) in nonpregnant reproductive-aged women. In some instances the abnormal bleeding may emanate from definable pathologic entities in the endometrial cavity such as polyps or submucous leiomyomas (fibroids), while in others, it may occur secondary to coagulopathies or disorders of local or systemic hemostasis. If the patient is subjected to a rigorous evaluation more than one potential contributor may be identified, a circumstance that challenges the clinician since entities such as polyps, leiomyomas, and adenomyosis may frequently be asymptomatic, even in women with AUB. The bench or clinical investigator may also be influenced by the existence of the multiplicity of potential causes that could confound the results of research. This paper describes FIGO's (Fédération Internationale de Gynécologie et d'Obstétrique) new PALM-COEIN classification of causes of AUB in the reproductive years (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia-Coagulopathy, Ovulatory disorder, Endometrial, Iatrogenic, Not yet classified). This system is designed to assist clinicians in the evaluation of patients, investigators in the design and interpretation of research and faculty in the education of medical students and residents/trainees. Additionally, given the longstanding existence of a confusing array of conflicting definitions, the manuscript describes the FIGO standardized terminology for both normal menstruation and AUB symptoms.

[Causes of menstrual disorders in adolescent girls--a retrospective study]. / Przyczyny zaburzen miesiaczkowania u nastolatek--badanie retrospektywne.

INTRODUCTION: Adolescent girls often visit the outpatient endocrinological clinic because of menstrual disorders. The problem arises whether to recognize the menstrual cycle irregularity as a physiology of the adolescence or to initiate diagnostic procedures to exclude pathology. Although irregular menses during first 3 years after menarche are usually symptoms of hypothalamus-pituitary-ovary axis immaturity, it does not exclude disorders to be subject of diagnosis and treatment. THE AIM OF THE STUDY was to evaluate causes of menstrual disorders in adolescent girls, who visited the outpatient clinic of the Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, between 2001-2005. MATERIAL AND METHODS: The study comprised 76 patients, who visited the outpatient endocrinological clinic because of menstrual disorders. Only the girls at least 2 years after menarche or with amenorrhoea primaria were included. The following parameters were analyzed: age, age of menarche, height and body mass, BMI, evidences of androgen excess, hormone levels, gynecological and ultrasound examination. RESULTS: Average age in the examined group was 16.2 years (min 12.5, max 20), average age of menarche was 12.5 years. Evidence of androgens excess were found in 48 patients (63.2%). The girls were coming to the clinic most often because of rare menses, most rarely because of primary lack of menstruation. Depending on the type of disorders they were divided into five groups: group I--amenorrhoea primaria--4 patients (5.3%), group II--amenorrhoea secundaria--14 patients (18.4%), group III--oligomenorrhoea--38 patients (50%), group IV--polymenorhea--8 patients (10.5%), group V--mixed disorders--12 patients (15.8%). The causes of menstrual disorders depended on the group. CONCLUSIONS: 1. Menstruation cycles irregularity in the first years after menarche may be a symptom of pathology demanding diagnosis and treatment. 2. PCO should be taken into consideration as a frequent cause of menstrual disorders in adolescent girls.

Characteristics of menstruation-related problems for adolescents and premarital women in Korea.

OBJECTIVE: This study was undertaken to compare the patterns of menstruation-related problems between adolescents and premarital women who visited the Young Lady Clinic (YLC) at Samsung Medical Center. STUDY DESIGN: This study includes 646 adolescents (aged 10-20, group I) and 591 premarital young women (aged 21-30, group II) who visited the YLC with menstruation-related problems (amenorrhea, oligomenorrhea, dysmenorrhea, abnormal uterine bleeding (AUB), etc.). Comparisons between the two groups were made with the use of chi(2)-test and Fisher's exact test. RESULTS: For primary amenorrhea, hypogonadotropic hypogonadism was more frequent in group I (p = 0.007), and eugonadism in group II (p = 0.0025). Chromosomal competent ovarian failure (p = 0.003) and hyperprolactinemia (p < 0.001) were more frequent causes of secondary amenorrhea in group II. Endometriosis without ovarian endometrioma was the more frequent laparoscopic finding for patients of group I (p = 0.0429). Regarding AUB, dysfunctional uterine bleeding (DUB) was more frequent for group I (p < 0.001) and endocrinopathies (p = 0.006) and benign lesions of genital tract (p < 0.0001) for group II. CONCLUSION: The menstruation-related problems showed different features for each group. These data might give us an insight, at least in part, into the menstruation-related problems of Korean young women.

Traditional phytoremedies for the treatment of menstrual disorders in district Udhampur, J&K, India.

ETHNOPHARMACOLOGICAL RELEVANCE: Herbal remedies form an integral part of healing and are considered to be the oldest forms of health care known to mankind. The present study aims to document traditional phytoremedies for the treatment of menstrual disorders in Udhampur district of J&K, India. MATERIAL AND METHODS: The informants were interviewed directly and information was gathered about plants used in different menstrual disorders. The data was further analyzed for use-value (UV), factor informant consensus (Fic) and fidelity level (Fl). RESULTS: In all, 62 informants were interviewed. Most of the informants (66%) were females. The patients prefer female healers over male vaids and hakims. A total of 50 plants were used to cure different menstrual disorders. Seeds were found to be of utmost medicinal importance (43.8%) followed by leaves (20.8%) and fruits (16.7%). Oral administration was observed to be the main mode (90.0%) of intake of medicine. The plants with high use-value were Triticum aestivum (UV=1.76), Taraxacum officinale (UV=1.16), Citrus limon (UV=0.95), Allium cepa (UV=0.79), Cicer arietinum (UV=0.77), Trigonella foenum-graecum (UV=0.66), Rubia manjith (UV=0.56), Ocimum tenuiflorum (UV=0.56) and Oryza sativa (UV=0.52). The various menstrual disorders were classified into 7 categories. The values of Fic varied between 0.96 (dysmenorrhea, itching and foul smell) and 0.92 (menorrhagia). The 100% Fl value was scored by 20 plants. Leucorrhea reported the highest 5 plants with 100% Fl. Nearly 40% of the formulations had two or more plants. CONCLUSION: Plants used for the treatment of different menstrual disorders were documented and analyzed for ethnogynecological problems. The study revealed some plants like Triticum aestivum, Rubia manjith, Dalbergia sissoo, Raphanus sativus, Citrus limon, Allium cepa, Trigonella foenum-graecum, Elettaria cardamomum etc. to be of great importance vis a vis menstrual disorders. Further pharmacological studies of these plants may provide some important drugs for the treatment of common menstrual disorders.

Abnormal uterine bleeding. Diagnostic considerations, management options.

The approach to diagnosis of abnormal uterine bleeding is guided by a sound knowledge of menstrual physiology and differential diagnosis. Often, simple anovulation is the underlying problem, although the possibility of pregnancy, endometrial hyperplasia with atypia, or benign reproductive tract disease must be considered. In the majority of cases, abnormal uterine bleeding can be fully evaluated and effectively treated medically without the need for gynecologic referral.

Treatment strategies for menstrually related migraine.

Approximately 50% of migrainous women suffer from menstrually related migraine (MRM), a type of migraine in which the attacks occur at the same time as or near the menstrual flow. Attacks of MRM tend to be longer, more intense and disabling and sometimes less responsive to treatment than non-menstrual migraines. Similar to the management of non-menstrual migraine, the use of triptans and NSAIDs is the gold standard for MRM treatment. In this paper, the most important studies in the literature that report the effectiveness of triptans, of certain associated drugs and other analgesic agents are summarized. Preventive strategies that can be used if a prophylactic treatment is needed is also analyzed, with particular attention paid to the use of perimenstrual prophylaxis with triptans and/or NSAIDs. Moreover, considering the peculiar interaction between menstrual migraine and female sex hormones, brief mention is made to possible hormonal manipulations.

An international response to questions about terminologies, investigation, and management of abnormal uterine bleeding: use of an electronic audience response system.

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.

The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding.

To this juncture, clinical management, teaching of medical providers, and the design and interpretation of clinical trials has been hampered by the absence of a consensus system for the classification of causes or potential causes of abnormal uterine bleeding (AUB). Indeed, more than one possible mechanism may be involved in the development of the bleeding symptoms experienced by a given individual. A consistent and universally accepted classification system could be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. The "PALM-COEIN" AUB classification system is the result of several years of collaboration among a spectrum of individuals involved in clinical medicine, teaching, and the basic and clinical sciences and is proposed as a tool that meets the requirements just described but one that is capable of adaptation to our evolving insight into the mechanisms involved in the genesis of AUB. This system has been accepted by the International Federation of Gynecology and Obstetrics (FIGO) as a suitable system for widespread international use.

The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding.

Over the past 5 years there has been a major international discussion aimed at reaching agreement on the use of well-defined terminologies to describe the normal limits and range of abnormalities related to patterns of uterine bleeding. This article builds on concepts previously presented, which include the abandonment of long-used, ill-defined, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The term DYSFUNCTIONAL UTERINE BLEEDING should also be discarded. Alternative terms and concepts have been proposed and defined. The terminologies and definitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and definitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group.

A five-year international review process concerning terminologies, definitions, and related issues around abnormal uterine bleeding.

Over the past decade there has been an increasing realization about the extent of confusion associated with the many terminologies used to describe abnormal uterine bleeding (AUB). This led to the organization of an international workshop of 35 experts from 15 countries in Washington, D.C., USA, in 2005, which addressed the confusions and controversies around AUB. The workshop comprehensively addressed anomalies in the terminologies, definitions, and causes of AUB. It also began to address broader issues including investigations, quality of life, the need for structured symptom questionnaires, cultural aspects, and future research needs. This workshop led to a series of recommendations and publications and to the establishment of the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Working Group. Since then, a series of international presentations and small group workshops has resulted in a wide awareness of the program and a comprehensive series of recommendations and publications. A particularly influential large-scale interactive workshop with 600 attendees was held during the 2009 FIGO World Congress, which demonstrated the broad acceptability of the current recommendations. This article describes the process leading to the development of international recommendations on terminologies, definitions, and classification of causes of AUB and the establishment of the FIGO Menstrual Disorders Working Group.

Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding.

OBJECTIVE: There has been increasing recent recognition of the worldwide confusion in the terminology and definitions for abnormalities of menstrual and uterine bleeding. The present review was undertaken to objectively explore some of the origins and current uses of terms for symptoms, signs, and causes of abnormal uterine bleeding and to demonstrate the international lack of uniformity. DESIGN: A detailed, but not systematic, search of the huge current and historical literature across the range of menstrual terminology, definitions, and some causes, with an emphasis on "menorrhagia" and "dysfunctional uterine bleeding." SETTING: An international collaboration to study ways of reaching worldwide agreement on descriptive terms and definitions for abnormal bleeding. RESULT(S): A large number of synonyms and overlapping terms for heavy menstrual bleeding have been identified, as well as smaller numbers of terms for other symptoms and causes of abnormal uterine bleeding. The origins and meanings of several of these terms have been explored in detail and wide variations in meaning demonstrated. CONCLUSION(S): There is great confusion in the way these terminologies are used and there is an urgent need for international agreement on consistent use of terms and definitions for symptoms, signs, and causes of abnormal uterine bleeding.

Standardizing the descriptive terminology of abnormal menstrual bleeding: it is time we talk the same talk.

The movement towards international standardization of the terminology used to describe abnormal uterine bleeding and of the definition that sets the boundaries of normal menstrual bleeding will greatly benefit clinicians and researchers.

Abnormal uterine bleeding, a new terminology is needed.

The current terminology describing abnormal uterine bleeding (AUB) is not universally agreed upon. A new AUB terminology must be uniform, unambiguous, and symptom focused. A prototype letters and numbers formula covering the entire spectrum of AUB is proposed that may contain sequences such as B1D2F1A2P1 (i.e., moderate-1 bleeding, lasting for 2 days-duration, with frequent monthly-1 presentation, causing significant-anemia and mild-1 pains). Universal acceptance of a similar standard and reproducible terminology will add semiquantitative information, enable accurate reporting, and facilitate clinical research.