Uterine bleedings and quality of woman's life


  • Ю. Г. Антипкін SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Ukraine
  • Ю. П. Вдовиченко P.L. Shupik NMAPE; Ukrainian Association of Perinatal Medicine, Ukraine https://orcid.org/0000-0001-5768-0973
  • А. Грациоттін Center for Gynecology and Medical Sexology of H. San Raffaele Hospital in Milan, Italy, Ukraine
  • В. В. Камінський P.L. Shupyk NMAPE; Association of Obstetricians and Gynecologists of Ukraine, Ukraine https://orcid.org/0000-0002-5369-5817
  • Т. Ф. Татарчук SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; Ukrainian Association of Endocrine Gynecology, Ukraine https://orcid.org/0000-0002-5498-4143
  • О. В. Булавенко Vinnytsia, Ukraine
  • О. В. Грищенко Kharkiv, Ukraine
  • З. М. Дубоссарська Dnipro, Ukraine
  • Ю. О. Дубоссарська Dnipro, Ukraine
  • Н. Я. Жилка Kyiv, Ukraine
  • Г. В. Зайченко Kyiv, Ukraine
  • В. П. Квашенко Kyiv, Ukraine
  • Н. В. Косей Kyiv, Ukraine
  • О. М. Макарчук Ivano-Frankivsk, Ukraine
  • Н. Ю. Педаченко Kyiv, Ukraine
  • В. І. Пирогова Lviv, Ukraine
  • Н. М. Рожковська Odesa, Ukraine




resolution of Advisory Board, abnormal uterine bleeding, menstrual symptoms, combined oral contraceptives, hormonal free interval


On March 12, 2019, an Advisory Board on impact of uterine bleedings on the quality of life of a woman was held in Kyiv, with participation of leading Ukrainian and European experts.

According to opinion of international experts (guidelines of the UK National Institute for Health and Care Excellence and the International Federation of Gynecology and Obstetrics from 2018), the choice of patient management tactics is not determined by measuring blood loss, but by the patient’s well-being (distress, decrease of work ability, sexual activity and quality of life).

Menstrual inflammation is phisiological and menstrual symptoms are usually mild/minor or absent when three criteria are fulfilled: resolving (normal cytoarchitecture of the tissue is reconstructed, endometrium first); limited in time; adequate and sufficient by intensity to finalize the reconstruction to the histological and functional characteristics of the different tissues involved. At the same time, if local and systemic inflammation associated with menstruation is excessive by intensity and duration, it can cause different pathological symptoms. Severe menstrual symptoms are clinically correlated with local and systemic inflammation, which is not resolving (menstruation is excessive in duration and intensity). Therefore, reducing menstrual inflammation is important to reduce the frequency and intensity of menstrual symptoms and improve the quality of life of women of reproductive age.

Women need appropriate stable levels of estrogen and progesterone to optimize their physical and mental health. During combined oral contraceptives selection for healthy women it is reasonable to give preference to contraceptives with short hormonal free interval (24+4, 26+2) compared to the traditional regimen (21+7), since the reduction of this interval provides a more stable level of estradiol, reduces the risk of casual ovulation in case of missed pill, increases contraceptive efficacy in comparison with the traditional regimen and reduce the incidence of hormone-withdrawal associated symptoms.

Author Biographies

Ю. Г. Антипкін, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

MD, professor, academician of the NAMS of Ukraine, academician-secretary of the Clinical Medicine Department of the NAMS of Ukraine, director

Ю. П. Вдовиченко, P.L. Shupik NMAPE; Ukrainian Association of Perinatal Medicine

MD, professor, corresponding member of the NAMS of Ukraine, first vice rector;


А. Грациоттін, Center for Gynecology and Medical Sexology of H. San Raffaele Hospital in Milan, Italy

MD, professor, director

В. В. Камінський, P.L. Shupyk NMAPE; Association of Obstetricians and Gynecologists of Ukraine

MD, professor, corresponding member of the NAMS of Ukraine, head of the Obstetrics, Gynecology and Reproductology Department;

chief specialist in Obstetrics and Gynecology at the Ministry of Health of Ukraine;

executive director

Т. Ф. Татарчук, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; Ukrainian Association of Endocrine Gynecology

MD, professor, corresponding member of the NAMS of Ukraine, deputy director for research work, head of the Endocrine Gynecology Department;



  1. Graziottin, A. “The shorter, the better: A review of the evidence for a shorter contraceptive hormone-free interval.” Eur J Contracept Reprod Health Care 21.2 (2016): 93–105.
  2. Thomas, S.L., Ellertson, C. “Nuisance or natural and healthy: should monthly menstruation be optional for women?” Lancet 355.9207 (2000) :922–4.
  3. Menzies, F.M., Shepherd, M.C., Nibbs, R.J., et al. “The role of mast cells and their mediators in reproduction, pregnancy and labour.” Hum Reprod Update 17.3 (2011): 383–96.
  4. Maybin, J.A., Critchley, H.O. “Progesterone: a pivotal hormone at menstruation.” Ann N Y Acad Sci 1221 (2011): 88–97.
  5. Berbic, M., Fraser, I.S. “Immunology of normal and abnormal menstruation.” Women’s Health (Lond Engl) 9 (2013): 387–95.
  6. Berbic, M., Ng, C.H., Fraser, I.S. “Inflammation and endometrial bleeding.” Climacteric 23 (2014): 1–7.
  7. Lockwood, C.J. “Mechanisms of normal and abnormal endometrial bleeding.” Menopause 18.4 (2011): 408–11.
  8. Maybin, J.A., Critchley, H.O., Jabbour, H.N. “Inflammatory pathways in endometrial disorders.” Mol Cell Endocrinol 335.1 (2011): 42–51.
  9. Evans, J., Salamonsen, L.A. “Inflammation, leukocytes and menstruation.” Rev Endocr Metab Disord 13.4 (2012): 277–88.
  10. Graziottin, A., Skaper, S.D., Fusco, M. “Mast cells in chronic inflammation, pelvic pain and depression in women.” Gynecol Endocrinol 30.7 (2014): 472–7.
  11. Berkley, K.J. “Primary dysmenorrhea: an urgent mandate.” International Association for The Study of Pain 21.3 (2013): 1–8.
  12. Latthe, P. “Sono stati considerati rispettivamente 3 studi randomizzati per la quantità e 5 studi randomizzati per la durata. Systematic review.” BMJ 332 (2006): 7475.
  13. Latthe, P., Mignini, L., Gray, R., et al. “Factors predisposing women to chronic pelvic pain: systematic review.” BMJ 332.7544 (2006): 749–55.
  14. Graziottin, A., Skaper, S.D., Fusco, M. “Inflammation and Chronic Pelvic Pain: A Biological Trigger for Depression in women?” J Depress Anxiety 3 (2013): 142–50.
  15. Sulak, P.J., Scow, R.D., Preece, C., et al. “Hormone withdrawal symptoms in oral contraceptive users.” Obstet Gynecol 95.2 (2000): 261–6.
  16. Martin, V.T., Lipton, R.B. “Epidemiology and biology of menstrual migraine.” Headache 48 Suppl 3 (2008): S124–30.
  17. Bertone-Johnson, E.R., Ronnenberg, A.G., Houghton, S.C., et al. “Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women.” Hum Reprod 29.9 (2014): 1987–94.
  18. Miller, A.H., Maletic, V., Raison, C.L. “Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression.” Biol Psychiatry 65.9 (2009): 732–41.
  19. Raison, C.L., Capuron, L., Miller, A.H. “Cytokines sing the blues: inflammation and the pathogenesis of depression.” Trends Immunol 27.1 (2006): 24–31.
  20. Dratva, J., Schindler, C., Curjuric, I., et al. “Perimenstrual increase in bronchial hyperreactivity in premenopausal women: results from the population-based SAPALDIA 2 cohort.” J Allergy Clin Immunol 125.4 (2010): 823–9.
  21. Brynhildsen, J. “Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks.” Ther Adv Drug Saf 5.5 (2014): 201–13.
  22. FSRH Guideline. Combined Hormonal Contraception (2019).
  23. Rible, R.D., Mishell, D.R. Jr. “Decreasing the number of days of the hormone-free interval with use of low-dose oral contraceptive formulations.” Gynaecol Forum 13 (2008): 2.
  24. Hauck, B.A., Brown, V. “A primer on the hormone-free interval for combined oral contraceptives.” Curr Med Res Opin 31.10 (2015): 1941–8.
  25. Aubeny, E., Buhler, M., Colau, J.-C. “Oral contraception: patterns of non-compliance. The coraliance study.” Eur J Contracept Reprod Health Care 7.3 (2002): 155–61.
  26. Willis, S.A., et al. “Greater inhibition of the pituitary-ovarian axis in oral contraceptive regimens with a shortened hormone-free interval.” Contraception 74.2 (2006): 100–3.
  27. Klipping, C., Duijkers, I., Trummer, D., Marr, J. “Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen.” Contraception 78.1 (2008): 16–25.
  28. Anttila, L., Kunz, M., Marr, J. “Bleeding pattern with drospirenone 3 mg + ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive.” Contraception 80 (2009): 445–51.
  29. Fraser, I.S., et al. “Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest.” Eur J Contracept Reprod Health Care 16.4 (2011): 258–69.
  30. Jensen, J.T., Parke, S., Mellinger, U., et al. “Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial.” Obstet Gynecol 117.4 (2011): 777–87.
  31. Barnett, et al. “Fertility and combined oral contraceptives – unintended pregnancies and planned pregnancies following oral contraceptive use – results from the INAS-SCORE study.” The European Journal of Contraception & Reproductive Health Care 22.1 (2017): 17–23.
  32. Yonkers, K.A., Brown, C., Pearlstein, T.B., et al. “Efficacy of a new lowdose oral contraceptive with drospirenone in premenstrual dysphoric disorder.” Obstet Gynecol 106.3 (2005): 492–501.
  33. Pearlstein, T.B., Bachmann, G.A., et al. “Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation.” Contraception 72.6 (2005): 414–21.
  34. Macìas, G., Merki-Feld, G.S., Parke, S., et al. “Effects of a combined oral contraceptive containing oestradiol valerate/dienogest on hormone withdrawal-associated symptoms: Results from the multicentre, randomised, double-blind, active-controlled HARMONY II study.” Journal of Obstetrics and Gynaecology 33.6 (2013): 591–6.
  35. Petraglia, F., Parke, S., Serrani, M., et al. “Estradiol valerate plus dienogest versus ethinylestradiol plus levonorgestrel for the treatment of primary dysmenorrhea.” Int J Gynaecol Obstet 125.3 (2014): 270–4.
  36. Ahrendt, H.J., Makalova, D., Parke, S., et al. “Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinyl estradiol/levonorgestrel.” Contraception 80 (2009): 436–44.
  37. Heitkemper, M.M., et al. “Relationship of Bloating to other GI and Menstrual Symptoms in Women with Irritable Bowel Syndrome.” Digestive Diseases and Sciences 49.1 (2004): 88–95.
  38. Graziottin, A., Serafini, A. “Perimenstrual asthma: from pathophysiology to treatment strategies.” Multidiscip Respir Med 11 (2016): 30.
  39. Walsemann, K.M., Perez, A.D. “Anxiety's relationship to inconsistent use of oral contraceptives.” Health Educ Behav 33 (2006): 197–214.
  40. Munro, M.G., et al. “The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.” International Journal of Gynecology & Obstetrics 143.3 (2018): 393–408.
  41. NICE guidelines. Heavy menstrual bleeding: assessment and management (2018).
  42. MoH of Ukraine. Clinical protocol for the management of patients with abnormal uterine bleeding, implemented in accordance with the Order of the Ministry of Health of Ukraine dated April 13, 2016, No. 353.
  43. American College of Obstetricians and Gynecologists. “Management of acute abnormal uterine bleeding in non-pregnant women. Committee Opinion №557.” Obstet Gynecol 121 (2013): 891–6.
  44. Singh, S., Best, C., Dunn, S., et al; Clinical practice – Gynaecology Committee of SOGC. “Abnormal Uterine Bleeding in Pre-Menopausal Women. SOGC Practice Bulletin No. 292.” J Obstet Gynaecol Can 35.5 (2013): 473–5.
  45. National Collaborating Centre for Women’s and Children’s Health; National Institute for Health and Clinical Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline (2018).



How to Cite

Антипкін, Ю. Г., Вдовиченко, Ю. П., Грациоттін, А., Камінський, В. В., Татарчук, Т. Ф., Булавенко, О. В., Грищенко, О. В., Дубоссарська, З. М., Дубоссарська, Ю. О., Жилка, Н. Я., Зайченко, Г. В., Квашенко, В. П., Косей, Н. В., Макарчук, О. М., Педаченко, Н. Ю., Пирогова, В. І., & Рожковська, Н. М. (2019). Uterine bleedings and quality of woman’s life. REPRODUCTIVE ENDOCRINOLOGY, (47), 8–12. https://doi.org/10.18370/2309-4117.2019.47.8-12



Health care