Causes and treatment of abnormal uterine bleeding

Abnormalna (nenormalna) krvarenja iz maternice (NKM) su jedan od najčešćih razloga zbog kojeg žene traže liječničku pomoć. Procjenjuje se da će otprilike 30% žena u nekom periodu svog života doživjeti abnormalno krvarenje iz maternice (engl. abnormal uterine bleeding – AUB). Uz to što imaju negativan utjecaj na kvalitetu života žena, NKM predstavljaju i veliko financijsko opterećenje zdravstvenog sustava. S obzirom na mnogobrojnost uzroka abnormalnih krvarenja iz maternice, dotadašnji termini kojima ih se pokušalo definirati (menoragije, menometroragije, metroragije, disfunkcionalno krvarenje iz maternice, itd) bili su zbunjujući i neprecizni. Iz tog razloga, Svjetska udruga ginekologa i opstetričara (FIGO) stvorila je novu standardiziranu klasifikaciju utemeljenu na uzrocima i kliničkoj praksi. Ona je određena akronimom PALM-COEIN prema prvim slovima uzroka poremećaja te je njome omogućeno razdvajanje strukturnih (PALM) i nestrukturnih (COEIN) NKM te prikaz više istovremenih uzroka.Liječenje NKM će primarno ovisiti o hitnosti (obilnost NKM i hemodinamska stabilnostžene), uzrocima, dobi i reprodukcijskim željama žene. Kao prva linije liječenja,preporuča se primjena medikamentne terapije poput kombiniranih oralnihkontraceptiva ili intrauterinog sustava s levonorgestrelom (LNG-IUS). Kirurško jeliječenje rezervirano za ona NKM koja su refraktorna na bilo koju medikamentnu terapiju i ozbiljnije ugrožavaju zdravlje ili život žene, te u onih pacijentica koje nemaju želja za daljnjom reprodukcijom.Abnormal uterine bleeding (AUB) is one of the most common reasons for women to seek medical care. Approximately 30% of women will experience abnormal uterine bleeding during their lifetime. AUB has a negative impact on the quality of life and represents a major financial burden for the health system. Historically a lot of terms were used in connection AUB (such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, etc.). None of them could be related to certain etiology or further clinical work-up. Therefore, the International Federation of Gynecology and Obstetrics (FIGO) has developed a new standardized classification based on the etiology and clinical practice. It is called PALM-COEIN – the name was derived from the acronym using the first letters of the causes of the AUB. This classification makes it possible to differentiate structural (PALM) and non- structural (COEIN) causes of AUB. Simultaneous etiologies are also incorporated in the aforementioned classification. Treatment of AUB primarily depends on the urgency (abundance of AUB and hemodynamic stability). Etiology, age and reproductive wishes are also taken into account. First line of treatment is medical therapy usually consisting of combined oral contraceptives or levonorgestrel intrauterine system (LNG-IUS). Surgical treatment is reserved for AUB that is either unresponsive to medical therapy or seriously endangers the health of patients. Patient that desires no further reproduction is also a candidate for surgical treatmen