Abnormal uterine bleeding: etiology and pathogenesis (descriptive review)
Background: Despite advances in medicine, uterine bleeding remains a well-known medical problem. Abnormal uterine bleeding has a negative impact on the physical, emotional, social, incl. material well-being of the female population. About a third of all women seek medical help from a gynecologist in connection with abnormal uterine bleeding. Their frequency increases with age: if in the reproductive age it is 20-30%, then in the period of peri- and postmenopause it increases to 80%. Abnormal uterine bleeding ranks second among the reasons for hospitalization of women to gynecological inpatient facilities and are indications for most surgical interventions, including destructive. The aim of the study: To consider the etiology and pathogenesis of abnormal uterine bleeding, modern terminology and classification systems, based on the recent data of guidelines and studies of recent years. It will allow to systematize the knowledge of researchers and clinicians about this problem and will help to choose the optimal therapy method. Materials and methods: We analyzed the literature data on the problem of abnormal uterine bleeding published over the past 10 years. The resources PubMed, Elibrary, Scopus were used to analyze the data. Results: The analysis of literature sources showed that the problem of abnormal uterine bleeding and possible ways to solve it is still relevant and is the focus of attention of clinicians, researchers, international gynecological societies, and is considered in international recommendations. The use of a unified terminology and the universal classification system for abnormal uterine bleeding, proposed by the International Federation of Gynecology and Obstetrics made it possible to systematize knowledge about this problem, resolve difficulties in conducting scientific research and develop standards for patient management. Conclusion: The International Federation of Gynecology and Obstetrics recommends using the PALM-COEIN system to classify causes of abnormal uterine bleeding, which includes structural and non-structural causes of bleeding, excluding gestational causes. The etiological diagnosis determines the method of therapy of uterine bleeding and is directly related to the success of treatment. Knowledge of the pathogenesis fundamentals of uterine bleeding will allow the development of new diagnostic and monitoring tools that will help stratify the treatment of women with abnormal uterine bleeding, especially in relation to "endometrial" and "unclassified" causes.
Enkova ЕV, Kiseleva ЕV, Khoperskaya OV, et al. Abnormal uterine bleeding: etiology and pathogenesis (descriptive review). Research Results in Biomedicine. 2022;8(3):365-381. Russian. DOI: 10.18413/2658-6533-2022-8-3-0-8
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