Abnormal uterine bleeding (AUB)
A 42-year-old multiparous woman complains of irregular bleeding for two months. The haemoglobin percentage is 9 g/dl. What is the best treatment option?
Abdominal and vaginal examinations are normal. Transvaginal ultrasound scan reveals an endometrial thickness of 17 mm. Endometrial biopsy reveals simple endometrial hyperplasia without atypia.
- Administer combined oral contra ceptive pills for 3 cycles.
- Administer norethisterone 5 mg three times daily for 3 cycles.
- Insert a levonorgestrel-releasing intra uterine device.
- Perform endometrial ablation.
- Perform a hysterectomy.
Hyperplasia The risk of endometrial without atypia progressing to endometrial cancer is less than 5% over 20 years and the majority will regress spontaneously during follow-up. Therefore, endometrial ablation or hysterectomy is not necessary. Observation alone with follow-up endometrial biopsies, to ensure disease regression is recommended in women without symptoms and who are at low risk of endometrial carcinoma. Treatment with progesterone is indicated in this woman as she has bleeding. Also progesterone will cause regression of the hyperplasia. Insertion of a levonorgestrel-releasing intrauterine device is the best treatment option, because compared to oral progesterone it is more effective to control bleeding and to cause regression of the hyperplasia. It will also provide effective contraception. It has fewer side effects. If oral norethisterone is given, the treatment should be given continuously for 6 months. Cyclical treatment should not be used because it is less effective in inducing regression of endometrial hyperplasia.