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.

FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

“…Consequently, they would be referenced in the relevant category, but detail would be left to the appropriate disease-specific classification, grading, or staging system. The Cape Town audience was polled [14], with 96/141 (68.1%) supporting the proposal that "coagulopathy," "endometrial dysfunction," and "ovulatory disorders" replace the collection of disorders previously encompassed by the discarded term "DUB" [15].…”

The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding

“…This Working Group also assisted in designing questions to test the acceptability of the recommended terminologies, definitions, and classifications with a large multicultural audience in the Congress on Abnormal Uterine Bleeding Symposium using the Audience Responder System. 8 The recommendations presented here are the result of an extensive discussion and testing process but should still be regarded as a flexible living document, scheduled for future review through the FIGO Menstrual Disorders Working Group and sessions at FIGO World Congresses.…”

“…''The menopause'' is the last natural menstrual period that a woman will experience and can only be determined in retrospect when a year of amenorrhea has followed it. PMB is an important symptom because of its common Acute or Chronic Abnormal Uterine Bleeding 8 It is proposed that acute AUB is ''an episode of bleeding in a woman of reproductive age, who is not pregnant, that is of sufficient quantity to require immediate intervention to prevent further blood loss.'' Chronic AUB is ''bleeding from the uterine corpus that is abnormal in duration, volume, and/or frequency and has been present for the majority of the last 6 months.…”

New ground breaking International Federation of Gynecology and Obstetrics′s classification of abnormal uterine bleeding: Optimizing management of patients

“…Because of lack of availability in many countries, the use of magnetic resonance imaging (MRI) for characterization of structural lesions of the uterus was not feasible; therefore, use of MRI was not included as a mandatory tool to classify patients with chronic AUB. [67]…”