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Primary Care Management of Abnormal Uterine Bleeding [Internet]

Primary Care Management of Abnormal Uterine Bleeding [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: March 2013


This chapter presents the results of the systematic review of the literature on primary care management of abnormal uterine bleeding (AUB). We present findings for Key Question 1 (KQ1) beginning with an overview of the content of the literature as a whole, followed by results and detailed analysis organized first by studies addressing irregular uterine bleeding (KQ1A) and then by studies addressing abnormal cyclic uterine bleeding (KQ1B). When there are distinct populations in which the interventions have been studied such as enrollment based on differing criteria, we discuss related data together. Within KQs we present summary information in the order: devices, medications, lifestyle and behavioral interventions, and complementary and alternative medicine. Within a category such as medication, we organize the results from greater number of studies to fewer, and presented the results of placebo controlled trials before direct comparisons. These analyses are followed by review of the studies and supplemental information addressing KQ2, which pertains to harms associated with the interventions identified for KQ1.

Executive Summary

Abnormal uterine bleeding (AUB) is among the most common gynecologic complaints of reproductive-age women in ambulatory care settings. It is estimated to affect 11 to 13 percent of reproductive-age women at any given time. Prevalence increases with age, reaching 24 percent in women aged 36 to 40., Women generally present for care because the amount, timing, or other characteristics of the bleeding have changed from their individual norm. Population norms for menstrual bleeding, as established by 5th and 95th percentiles, are:-


We identified 1,775 nonduplicate publications through the search process, with 219 proceeding to full-text review (Figure 2). We included 41 publications that reported on 39 separate randomized controlled trials (RCTs) and 12 types of interventions. These studies evaluated the levonorgestrel-releasing intrauterine system (LNG-IUS; 7 studies),- the contraceptive vaginal ring (1 study), nonsteroidal anti-inflammatory drugs (NSAIDs; 13 studies),-,- tranexamic acid (TXA; 7 studies),,,- combined oral contraceptives (COCs; 6 studies),,,,,, metformin (4 studies),- exenatide (1 study), progestogens (1 study), cabergoline (1 study), acupuncture (2 studies),, lifestyle/behavioral changes (1 study), and patient decision aids (3 studies),, using at least one comparator or placebo arm.

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