Abnormal uterine bleeding: how to prevent recurrence
Authors:   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Katkova N.Yu. , Baranova E.S. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Zhulina M.V. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Guseva O.I. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Malyshev V.V. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Soshnikov A.V. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation, Tanaev D.A. ,   Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
Published: February 2025

Abnormal uterine bleeding (AUB) is a common gynecological pathology not only in the Russian Federation, but also worldwide. The prevalence of AUB is 30% among reproductive-aged women and reaches 70% by perimenopause. Bleeding associated with ovulatory dysfunction (AUB-O) is the most frequent cause of non-organic AUB, accounting for up to 40% of all AUB cases. The category of AUB originating in the endometrium (AUB-E) can be assumed after excluding other detectable disorders, but in practice, AUB-O and AUB-E are diagnosed as a combined pathology. It is known that patients with AUB and anemia are more likely to suffer from anxiety and depression.
Objective. To assess the quality of life of reproductive-aged patients with AUB-O and AUB-E depending on the method of antirecurrence therapy. The study was conducted at the Department of Obstetrics and Gynecology, Faculty of Additional Professional Education, Privolzhsky Research Medical University (Nizhny Novgorod), at the Dzerzhinsk Perinatal Center in “Rost-Medicine-NN” LLC, as well as at the Maternity Hospital No 5.
Patients and methods. A total of 55 reproductive-aged women hospitalized in the gynecology unit with AUB-O and AUB-E were examined. All patients were divided into two groups depending on the treatment method. Group 1 included 25 patients who underwent surgical hemostasis. Group 2 included 30 women who received conservative non-hormonal hemostatic treatment. In each group, patients were divided into subgroups depending on the prescription of anti-recurrence therapy: subgroups 1A and 2A (with anti-recurrence therapy), subgroups 1B and 2B (without therapy). Dydrogesterone (Duphaston) at a dose of 20 mg daily from day 11 to day 25 of the menstrual cycle was used as medication therapy. The outcome was evaluated at three months after the episode of AUB. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS).
Results. The results of the study showed that in reproductive-aged patients with AUB-O and AUB-E, the preferred method to stop bleeding is conservative non-hormonal hemostasis, which is a safe and effective treatment option associated with moderate anxiety in women. The inclusion of dydrogesterone 20 mg daily from day 11 to day 25 of the menstrual cycle in this cohort of women as part of anti-recurrence therapy after an episode of acute AUB is pathogenetically justified and reduces the level of anxiety and anemia, leads to normalization of the psycho-emotional state.
Key words: abnormal uterine bleeding, reproductive age, surgical and hormonal hemostasis, level of anxiety and depression, anti-recurrence therapy, dydrogesterone