ABNORMAL UTERINE BLEEDING IN WOMEN OF REPRODUCTIVE AGE: ETIOPATHOGENESIS, CLINICAL MANIFESTATIONS, DIAGNOSIS, AND MODERN PRINCIPLES OF TREATMENT
Keywords:
abnormal uterine bleeding, reproductive age, PALM–COEIN, heavy menstrual bleeding, leiomyomaAbstract
Abnormal uterine bleeding (AUB) is one of the most common gynecological problems among women of reproductive age and has a significant impact on physical health, emotional well-being, fertility, working capacity, and quality of life. AUB refers to menstrual bleeding that differs from normal menstruation in frequency, regularity, duration, or volume. In modern gynecology, the evaluation of AUB is based on the FIGO PALM–COEIN classification, which divides causes into structural and non-structural groups. Structural causes include polyps, adenomyosis, leiomyoma, malignancy, and hyperplasia, while non-structural causes include coagulopathy, ovulatory dysfunction, endometrial disorders, iatrogenic causes, and causes not otherwise classified.
The clinical significance of AUB is high because it may be the first manifestation of anemia, endocrine disorders, polycystic ovary syndrome, uterine fibroids, endometrial hyperplasia, or, less commonly in reproductive age, malignant disease. Studies show that AUB affects a considerable proportion of reproductive-aged women; different sources estimate that approximately 14–25% of women of reproductive age experience AUB, while some global reports describe a prevalence close to 30%. A 2024 study also notes that AUB is a major cause of gynecological morbidity, affecting about one in five women during the reproductive period
This article analyzes the etiopathogenesis, clinical features, diagnostic algorithm, and modern treatment principles of AUB in reproductive-aged women. The paper is prepared in an IMRAD style using international guidelines, clinical recommendations, and evidence-based literature. The findings show that effective management of AUB requires individualized assessment, exclusion of pregnancy, evaluation of hemodynamic stability, identification of the underlying cause, correction of anemia, and selection of medical or surgical treatment according to the patient’s age, reproductive plans, severity of bleeding, and associated pathology
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