REGISTRO DOI: 10.69849/revistaft/ar10202410311010
Adriano de Lucena Jambo Cantarelli; Marcelo Ferreira Suzart Júnior; Maria Clara De Sá Pereira; Taiany Lima De Queiroz; Thiago da Silva Lima Nicácio; Lavínia Tenório Cardoso; Gabriel Cardoso Silva Mendonça; Álvaro Fellipe da Silva Oliveira; Maria Ramires Barbosa de Lima; Luiz Felipe Andrade Siqueira.
Summary
Introduction: Abnormal uterine bleeding is a medical condition that affects many women at different stages of their reproductive life and has been recognized as a significant public health concern. In recent years, the understanding of the causes and treatment options for this condition has evolved, reflecting the need for a comprehensive diagnostic and therapeutic approach. This condition is often related to hormonal imbalances, structural abnormalities, infections, and other gynecological diseases. Objective: To describe the importance of the diagnosis and therapeutic management of abnormal uterine bleeding, highlighting current clinical practices. Method: This is an integrative literature review, with the research question: what is the importance of the diagnosis and therapeutic management of abnormal uterine bleeding? The descriptors used were: “diagnosis,” “uterine bleeding,” and “therapeutics.” Searches were conducted in scientific platforms, resulting in the selection of 12 relevant articles published between 2019 and 2024. Results: The diagnosis of abnormal uterine bleeding is primarily based on specific clinical criteria, including a detailed menstrual history and physical examination. To confirm the condition, additional tests such as ultrasound and, in some cases, hysteroscopy are necessary, as well as excluding other potential causes like infections. The treatment of abnormal uterine bleeding varies depending on the identified cause and may include non-invasive options, such as hormonal medications, as well as surgical interventions for more severe cases. Conclusion: The management of abnormal uterine bleeding involves an individualized approach, starting with the identification of the underlying cause. Treatment may include the use of hormonal contraceptives and, when necessary, surgical interventions. Educating patients about their conditions and treatment options is essential for adherence to management and improving quality of life. Continuous follow-up and adaptation of treatment strategies are crucial to ensuring positive outcomes.
Keywords: Diagnosis. Uterine bleeding. Therapeutics.
1 INTRODUCTION
Abnormal uterine bleeding is a condition that affects many women at different stages of their reproductive life, and understanding it is essential for appropriate diagnosis and treatment. This condition can manifest in various forms, including irregular menstrual cycles, excessive bleeding, or bleeding that occurs outside of the menstrual period. Due to its variability, it is crucial for women to be attentive to the patterns of their menstrual cycles, as significant changes may indicate underlying problems.
Firstly, the causes of abnormal uterine bleeding are diverse and can include hormonal imbalances, which are often responsible for menstrual irregularities. These hormonal fluctuations can occur due to factors such as stress, changes in body weight, or pre-existing medical conditions like polycystic ovary syndrome. Additionally, structural conditions such as fibroids and polyps can contribute to increased menstrual flow and episodes of bleeding outside the usual cycle.
Another important aspect to consider is infections and other gynecological conditions, which can also result in abnormal bleeding. Infections such as cervicitis or endometritis can cause discomfort and changes in the menstrual cycle, as well as symptoms like abdominal pain and discharge. On the other hand, more serious diseases such as cervical or endometrial cancer, although less common, require special attention, as they can initially manifest through abnormal bleeding.
Seeking medical guidance is fundamental for the correct diagnosis of abnormal uterine bleeding. A gynecological evaluation may include physical examinations, ultrasounds, and, in some cases, biopsies, which help identify the cause of the problem. Additionally, the patient’s medical history, including information about menstrual cycles, associated symptoms, and risk factors, plays a crucial role in formulating an accurate diagnosis.
In summary, abnormal uterine bleeding is not just an inconvenience but a sign that may indicate health issues that require attention. Recognizing the symptoms and seeking medical guidance are essential steps to ensure effective treatment and, when necessary, appropriate interventions. Education and awareness about this condition can empower women to make informed decisions regarding their reproductive health, thus promoting overall well-being and improving quality of life.
2 THEORETICAL FOUNDATION OR LITERATURE REVIEW
Abnormal uterine bleeding is a condition that has been documented throughout medical history, reflecting ongoing concerns about women’s reproductive health. Ancient texts, such as those written by Hippocrates, already mentioned menstrual irregularities and their implications for women’s health. During the Middle Ages, the understanding of the menstrual cycle and its dysfunctions was limited, often associated with superstitious beliefs. With advances in medicine in the 19th and 20th centuries, professionals began to categorize and better understand the different types of abnormal bleeding, leading to increased focus on diagnosis and treatment.
Abnormal uterine bleeding is defined as any bleeding that differs from normal menstrual patterns and is classified into different types, including menorrhagia, metrorrhagia, and oligomenorrhea. According to the International Federation of Gynecology and Obstetrics, each of these types has distinct characteristics that aid in diagnosis. This comprehensive definition is essential for understanding symptoms and identifying possible underlying causes.
The causes of abnormal uterine bleeding are multifactorial, ranging from hormonal imbalances to anatomical conditions. According to the American College of Obstetricians and Gynecologists, hormones play a crucial role in the menstrual cycle, and when there is hormonal dysfunction, it can result in abnormal bleeding. For example, polycystic ovary syndrome is a condition that causes menstrual irregularities due to hormonal imbalances, affecting ovulation and consequently the bleeding pattern.
In addition to hormonal issues, structural factors can also contribute to abnormal uterine bleeding. According to the study by Kahn et al. (2019), fibroids and endometrial polyps are the most common structural abnormalities associated with uterine bleeding. These benign tumors can cause menorrhagia and metrorrhagia, necessitating diagnostic evaluations such as ultrasounds or hysteroscopies for appropriate management. Identifying and treating these conditions can alleviate symptoms and improve patients’ quality of life.
Gynecological infections are also an important consideration in the context of abnormal uterine bleeding. As pointed out by the work of Hwang et al. (2021), infections such as cervicitis and endometritis can lead to changes in the menstrual cycle and unexpected bleeding. Treating these infections not only addresses the symptom of bleeding but also prevents additional complications that could affect women’s reproductive health.
Finally, medical evaluation is crucial for the effective management of abnormal uterine bleeding. According to the review by Haimov-Kochman et al. (2020), the diagnostic approach should include a detailed clinical history, physical examination, and, when necessary, complementary tests. Early recognition of the underlying causes of abnormal uterine bleeding allows for appropriate interventions, promoting reproductive health and the overall well-being of women. Therefore, education and awareness about abnormal uterine bleeding are fundamental to empower women to seek help and ensure their health needs are met.
3 METHODOLOGY
Through a literature review, this work was conducted based on articles published in traditional national and international journals, prioritizing the core of the proposed theme, which emphasized both positive and negative qualitative aspects of the diagnosis and therapeutic management of abnormal uterine bleeding. The selected articles were listed in their most recent publications on the subject, between the years 2019 and 2024, using the following descriptors: “diagnosis,” “uterine bleeding,” and “therapeutics.”
4 RESULTS AND DISCUSSIONS OR DATA ANALYSIS
The diagnosis of abnormal uterine bleeding involves a comprehensive approach that combines clinical assessment with complementary examinations. Initially, the patient’s medical history is crucial, as it allows for the identification of bleeding patterns, duration, and intensity, as well as associated factors such as medication use, pre-existing health conditions, and menstrual history. According to the American College of Obstetricians and Gynecologists, gathering detailed clinical data is the first step toward an accurate diagnosis, since many causes of abnormal uterine bleeding may be related to hormonal or anatomical disorders.
After the medical history, it is common for the physician to perform a physical examination, including a pelvic exam, to assess the presence of visible abnormalities. Depending on the initial findings, complementary tests such as transvaginal ultrasound, hysteroscopy, and, in some cases, endometrial biopsy may be requested. According to the research by Kahn et al. (2019), ultrasound is particularly useful in detecting fibroids and polyps, which are common causes of abnormal uterine bleeding. Hysteroscopy, on the other hand, allows for direct visualization of the interior of the uterus, aiding in the identification of lesions that may not be detected by other methods.
Once the cause of the bleeding is established, therapeutic management should be individualized, taking into account the severity of symptoms, the underlying cause, and the patient’s reproductive desires. Treatment can range from conservative approaches, such as the use of hormonal medications, to surgical interventions. The use of hormonal contraceptives, for example, is often recommended to regulate menstrual cycles and reduce flow in cases of hormonal dysfunction. According to Haimov-Kochman et al. (2020), this approach can be effective for many women, providing symptomatic relief without the need for invasive procedures.
In situations where conservative treatments are insufficient or when there are significant anatomical conditions, surgical options may be considered. Myomectomy or hysterectomy are examples of interventions that may be necessary to treat fibroids or other structural abnormalities. The choice between these options should be made collaboratively with the patient, discussing the risks and benefits of each approach. Additionally, educating the patient about their condition and treatment options is crucial for successful management, as it increases adherence to treatment and improves overall satisfaction.
Finally, research on abnormal uterine bleeding has advanced in recent years, revealing new understandings of its causes and treatments. Current literature emphasizes the importance of accurate diagnosis and appropriate management to improve the quality of life for affected women. Therefore, the integration of clinical data, technological advancements, and a patient-centered approach are fundamental for the effective treatment of abnormal uterine bleeding, as evidenced by recent studies.
5 CONCLUSION/FINAL CONSIDERATIONS
It is concluded that abnormal uterine bleeding is a complex and multifactorial condition that requires a comprehensive diagnostic approach and individualized therapeutic management. Firstly, a detailed clinical evaluation, combined with complementary examinations, is essential to accurately identify the underlying causes and determine the most appropriate treatment. Furthermore, management options vary significantly, ranging from conservative interventions, such as hormonal medications, to surgical procedures in more severe cases. Additionally, patient education plays a crucial role in this process, providing valuable information that enables women to understand their conditions and treatment options. Active involvement of women in discussions about their options not only improves adherence to proposed interventions but also strengthens the physician-patient relationship, promoting more effective and compassionate care.
Therefore, as we advance in understanding abnormal uterine bleeding, it is essential that care practices are continually refined, incorporating new scientific evidence and innovative techniques. Ultimately, this integrated approach centered on women’s reproductive health aims not only for effective symptom control but also seeks to improve the quality of life for affected women, highlighting the importance of a healthcare system that prioritizes their needs and well-being.
REFERENCES
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HAIMOV-KOCHMAN, R. et al. Abnormal uterine bleeding: A review of the current management strategies. Journal of Women’s Health, v. 29, n. 3, p. 345-353, 2020.
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