What are the ACOG guidelines on the treatment of abnormal uterine bleeding (AUB)?

Updated: Dec 07, 2018
  • Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

In July 2013, The American College of Obstetricians and Gynecologists  issued updated guidelines for the treatment of abnormal uterine bleeding caused by ovulatory dysfunction. They included the following recommendations [7] [8] :

  • Surgery should be considered only in patients in whom medical treatment has failed, cannot be tolerated, or is contraindicated

  • Endometrial ablation is not acceptable as a primary therapy, because the procedure can hamper the later use of other common methods for monitoring the endometrium

  • Regardless of patient age, progestin therapy with the levonorgestrel intrauterine device should be considered; contraceptives containing a combination of estrogen and progesterone also provide effective treatment

  • Low-dose combination hormonal contraceptive therapy (20-35 μg ethinyl estradiol) is the mainstay of treatment for adolescents up to age 18 years

  • Either low-dose combination hormonal contraceptive treatment or progestin therapy is generally effective in women aged 19-39 years; high-dose estrogen therapy may benefit patients with an extremely heavy menstrual flow or hemodynamic instability

  • Medical treatment for women aged 40 years or older can, prior to menopause, consist of cyclic progestin therapy, low-dose oral contraceptive pills, the levonorgestrel intrauterine device, or cyclic hormone therapy

  • If medical therapy fails, patients should undergo further testing (eg, imaging or hysteroscopy)

  • An in-office endometrial biopsy is preferable to dilation and curettage (D&C) when examining a patient for endometrial hyperplasia or cancer

  • If medical therapy fails in a woman in whom childbearing is complete, hysterectomy without cervical preservation may be considered


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