Resolution of the II Ukrainian forum of experts on abnormal uterine bleeding

Authors

DOI:

https://doi.org/10.18370/2309-4117.2024.71.20-28

Keywords:

abnormal uterine bleeding, II Ukrainian Forum of experts on abnormal uterine bleeding, resolution

Abstract

Approaches to the diagnosis and treatment of abnormal uterine bleeding (AUB) are constantly updated due to the new results of clinical studies and in the process of revising international clinical guidelines. These updates need to be implemented in clinical practice. Therefore, on October 20, 2023, the II Ukrainian Forum of experts on AUB was held, the key provisions of which are outlined in this resolution.
A new multi-level three-component classification system «HyPO-P + GAIN-FIT-PIE» developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022 was presented at the Forum. FIGO experts anatomically grouped the causes of ovulation disorders into 4 groups: I – hypothalamic, II – pituitary, III – ovarian, IV – polycystic ovary syndrome (first level HyPO-P). Also, this classification system includes the second level GAIN-FIT-PIE (genetic, autoimmune, iatrogenic, neoplastic; functional, infectious, inflammatory, traumatic, vascular; physiological, idiopathic, endocrine) and the third level with examples of specific conditions within the subgroups of the second level. Correct classification of ovulation disorders is important for the AUB diagnosis and management, since ovulation disorders are associated with disorders of the menstrual cycle characteristics, which leads to the development of functional AUB.
In order to optimize the treatment of patients with AUB, the experts of the Forum developed an algorithm for the AUB management taking into account the individual approach and characteristics of the patient, which is based on the current FIGO classifications – PALM-COEIN (2018) and HyPO-P + GAIN-FIT-PIE (2022). According to
this algorithm, patient management tactics depend on the type of disorders (structural, functional), the patient’s reproductive stage (adolescence, active reproductive age, perimenopause) and the need for contraception. Hormonal drugs (combined oral contraceptives and progestogens) are main direction of pharmacotherapy of functional AUB. The high efficiency of dydrogesterone among the progestogens has been proven, starting from the first cycle of therapy.

Author Biographies

O.V. Bulavenko, Vinnytsia National Pirogov Memorial Medical University, Vinnytsia

MD, professor, head of Obstetrics and Gynecology Department No. 2

O.L. Gromova, Bogomolets National Medical University, Kyiv

PhD, assistant professor, Obstetrics and Gynecology Department of Postgraduate Education

Y.O. Dubossarska, Dnipro State Medical University, Dnipro

Obstetrics, Gynecology and Perinatology Department, Faculty of Postgraduate Education

T.O. Ermolenko, Odesa National Medical University, Odesa

MD, professor, Obstetrics and Gynecology Department No. 2

O.О. Yefimenko, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

PhD, senior researcher, Endocrine Gynecology Department

N.F. Zakharenko, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; Clinic "Institute of Family Planning", Kyiv

MD, professor, leading research fellow, Endocrine Gynecology Department;
Head of the scientific board of the clinic

N.V. Kosei, SSI “Center for Innovative Medical Technologies of the NAS of Ukraine», Kyiv

MD, professor, head of the Department of Reproductive Health

N.Y. Pedachenko, P.L. Shupyk National University of Health Care of Ukraine, Kyiv

MD, professor, Department of Obstetrics, Gynecology and Perinatology

V.I. Pyrohova, Danylo Halytsky Lviv National Medical University, Lviv

MD, head of the Obstetrics, Gynaecology and Perinatology Department, Faculty of Postgraduate Education

N.M. Rozhkovska, Odesa National Medical University, Odesa

MD, professor, Obstetrics and Gynecology Department

T.F. Tatarchuk, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; , SSI “Center for Innovative Medical Technologies of the NAS of Ukraine", Kyiv

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

T.M. Tutchenko, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”; SSI “Center for Innovative Medical Technologies of the NAS of Ukraine", Kyiv

PhD, senior researcher of the Endocrine Gynecology Department, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine”, Department of Reproductive Health of SSI “Center for Innovative Medical Technologies of the NAS of Ukraine", scientific consultant of “DILA” Medical Laboratory

O.G. Yashina, Medicom Clinic, Kyiv

PhD, leading specialist

References

  1. Order of the Ministry of Health of Ukraine dated April 13, 2016 No. 353 “On the approval and implementation of medical and technological documents on the standardization of medical care for abnormal uterine bleeding.” [Internet]. Kyiv: Verkhovna Rada of Ukraine, 2016. Available from: https://zakon.rada.gov.ua/rada/show/v0353282-16#Text
  2. Agents Stimulating Gonadal Function in the Human. Report of a World Health Organ Tech Rep Ser. 1973:514:1–30.
  3. Fertility problems: assessment and treatment. Clinical guideline [CG156]. [Internet]. National Institute for Health and Care Excellence. 2013 Feb 20. Available from: https://www.nice.org.uk/guidance/cg156
  4. Munro MG, Balen AH, Cho S, et al. The FIGO ovulatory disorders classification system. Int J Gynaecol Obstet. 2022 Oct;159(1):1–20. DOI: 10.1002/ijgo.14331.
  5. ESHRE Capri Workshop Group. Health and fertility in World Health Organization group 2 anovulatory women. Hum Reprod Update. 2012 Sep-Oct;;18(5):586–99.
  6. Beshay VE, Carr BR. Hypothalamic-pituitary-ovarian axis and control of the menstrual cycle. Clinical Reproductive Medicine and Surgery. 2013 Арг:31–42.
  7. Dangal G. Menstrual Disorders In Adolescents. [Internet]. IJGO. 2004 4(1). Available from: https://print.ispub.com/api/0/ispub-article/7501
  8. Bulun SE. Physiology and Pathology of the Female Reproductive Axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg H. Williams textbook of endocrinology [Internet]. Elsevier; 2016;574–641. Available from: https://www.scholars.northwestern.edu/en/publications/the-physiology-and-pathology-of-the-femalereproductive- axis-2.
  9. Marieb EN, Hoehn K. The Female Reproductive System: Hormonal Packet #31, Pearson Education Inc. 2010. [Accessed 17 Aug 2021].
  10. Dozortsev D, Diamond et al. Luteinizing hormone – independent rise of progesterone as the physiological trigger of the ovulatory gonadotropins surge in the human. Fertil Steril. 2020 Aug 114(2):191–199. DOI: 10.1016/j.fertnstert.2020.06.016
  11. Taraborrelli S. Physiology, production and action of progesterone. Acta Obstet Gynecol Scand 2015 Nov:94 Suppl 161: 8–16. DOI: 10.1111/aogs.12771.
  12. Lockwood CJ. Mechanisms of normal and abnormal endometrial bleeding. Menopause 2011 Apr;18(4):408–11. DOI: 10.1097/GME.0b013e31820bf288
  13. White BA. The Male and Female Reproductive Systems. In: Koeppen BM, Stanton BA. Berne & Levy Physiology. [6th Edition]. St Louis: Elsevier; 2010:758–97.
  14. Master-Hunter T, Heiman DL. Amenorrhea: Evaluation and Treatment. Am Fam Physician 2006 Apr 15;73(8):1374–82.
  15. Munro MG, Critchley HOD, Fraser IS. FIGO Menstrual Disorders Committee. 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. Int J Gynaecol Obstet. 2018 Dec;143(3):393–408. DOI: 10.1002/ijgo.12666
  16. Panay N, Pritsch M, Alt J. Cyclical dydrogesterone in secondary amenorrhea: Results of a double-blind, placebo-controlled, randomized study. Gynecol Endocrinol 2007 Nov 23(11):611–618. DOI: 10.1080/09513590701582554
  17. Practice Committee of American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril 2008 Nov 90(5 Suppl):S219–S225. DOI: 10.1016/j.fertnstert.2008.08.038
  18. Podfigurna A, Meczekalski B. Functional Hypothalamic Amenorrhea: A Stress-Based Disease. Endocrines. 2021 Jul 14;2(3):203-211. https://doi.org/10.3390/ endocrines2030020
  19. Gordon CM, Ackerman KE, Berga SL, et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 May 1;102(5):1413–39. DOI:10.1210/jc.2017-00131
  20. Sun Y, Wang Y, Mao L, et al. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study. Medicine (Baltimore). 2018 Aug;97(31):e11457. DOI:10.1097/MD.0000000000011457
  21. Munro MG, Balen AH, Cho S, et. at. The FIGO Ovulattory Disorders Classification System. Human Reprod. 2022 Aug 37(10):1–19. DOI:10.1093/humrep/ deac180
  22. Pitkin J. Dysfunctional uterine bleeding. BMJ 2007 May 26;334(7603):1110-1. DOI: 10.1136/bmj.39203.399502.BE
  23. Farrell E. Dysfunctional Uterine Bleeding. Aust Fam Physician 2004 Nov:33(11):906–8.
  24. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol. 1996; 175:766–769.
  25. Munro MG, Balen AH, Cho S, et al. The FIGO Ovulatory Disorders Classification System. Fertil Steril. 2022 Oct 118(4):768–86. DOI:10.1016/j.fertnstert.2022.07.009.
  26. Marret H, Fauconnier A, Chabbert-Buffet N, et al. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol. 2010 Oct;152(2):133-7. DOI: 10.1016/j.ejogrb.2010.07.016..
  27. Jones K, Sung S. Anovulatory Bleeding. [Internet]. 2021 Jan. [Last Update: July 9, 2023.]. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK549773/
  28. NICE guideline. Heavy menstrual bleeding: assessment and management. [Internet]. 14 March 2018. [Last updated: 24 May 2021]. Available from: https://www.nice.org.uk/guidance/ng88
  29. Schindler AE, Campagnoli C, Druckmann R, et al. Reprint of classification and pharmacology of progestins. Maturitas. 2008 Sep-Oct;61(1–2):171–80. DOI: 10.1016/j.maturitas.2008.11.013.
  30. Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration Climacteric. 2005 Aug:8 Suppl 1:3–63. DOI: 10.1080/13697130500148875
  31. Karakus S., Kiran G., Ciralik H. Efficacy of micronised vaginal progesterone versus oral dydrogestrone in the treatment of irregular dysfunctional uterine bleeding: a pilot randomised controlled trial. Aust N Z J Obstet Gynaecol. 2009 Dec;49(6):685–8. DOI: 10.1111/j.1479-828X.2009.01093.x.
  32. Podzolkova N, Tatarchuk T, Doshchanova A, et al. Dydrogesterone treatment for menstrual-cycle regularization in routine clinical practice: a multicenter observational study. Gynecol Endocrinol. 2016;32(3):246–9. DOI: 10.3109/09513590.2015.1115832.
  33. Trivedi N, Chauhan N, Vaidya V. Effectiveness and safety of dydrogesterone in regularization of menstrual cycle: a post-marketing study. Gynecol Endocrinol. 2016 Aug;32(8):667–671. DOI: 10.3109/09513590.2016.1152238.
  34. Tajjamal A, Zaman F. Severity of bleeding is a predictor of quality of life in women with heavy menstrual bleeding under dydrogesterone treatment in a prospective, multicentre, observational study. Gazz Med Ital 2015 Sept;174(9):391–398.
  35. Baber R.J., et al. IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016 Apr.19:2, 109–150. DOI: 10.3109/13697137.2015.1129166
  36. Rižner TL, Brožič P, Doucette C, et al. Selectivity and potency of the retroprogesterone dydrogesterone in vitro. Steroids. 2011 May;76(6):607-615. DOI:10,1016/j.steroids.2011.02.043.
  37. Schindler AE. Progestational effects of dydrogesterone in vitro, in vivo and on the human endometrium. Maturitas. 2009 Dec:65 Suppl 1:S3-S11. DOI:10.1016/j.maturitas.2009.10.011.
  38. Instructions for the medical use of the drug Duphaston®. [Internet]. Available from: https://mozdocs.kiev.ua/likiview.php?id=15524
  39. Instructions for the medical use of micronized progesterone (100 or 200 mg vaginal tablets). [Internet]. Available from: http://www.drlz.com.ua.
  40. Resolution of the First Ukrainian Forum of Experts on Abnormal Uterine Bleeding. Reproductive Endocrinology. 2021 Dec. 6(62):64–72. DOI: http://dx.doi.org/10.18370/2309-4117.2021.62.64-74.
  41. Order of the Ministry of Health of Ukraine dated 17.06.2022 No. 1039 “On approval of the Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care ‘Menopausal disorders and other disorders in the perimenopausal period’”. [Internet]. Kyiv: Ministryof healthof Ukraine, 2022. Available from: https://moz.gov.ua/article/ministry-mandates/nakazmoz-ukraini-vid-17062022--1039-pro-zatverdzhennjaunifikovanogo-klinichnogo-protokolu-pervinnoi-vtorinnoispecializovanoi-tretinnoi-visokospecializovanoi-medichnoi
  42. Order of the Ministry of Health of Ukraine dated 05.05.2021 No. 869 “On approval of the Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care ‘Endometrial hyperplasia’”. [Internet]. Kyiv: Ministryof healthof Ukraine, 2021. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-05052021--869-pro-zatverdzhennjaunifikovanogo-klinichnogo-protokolu-pervinnoi-vtorinnoispecializovanoi-tretinnoi-visokospecializovanoi-medichnoidopomogi-giperplazija-endometrija
  43. Order of the Ministry of Health of Ukraine dated 25.01.2023 No. 147 “On approval of the Standards of medical care for ‘Leiomyoma of the uterus’”. [Internet]. Kyiv: Ministryof healthof Ukraine, 2023. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-25012023--147-pro-zatverdzhennjastandartiv-medichnoi-dopomogi-lejomioma-matki
  44. Order of the Ministry of Health of Ukraine dated September 30, 2023 No. 1713 “On approval of the Standard of medical care ‘Malignant neoplasms of the uterine body’”. [Internet]. Kyiv: Ministryof healthof Ukraine, 2023. Available from:https://moz.gov.ua/article/ministry-mandates/nakazmoz-ukraini-vid-30092023--1713-pro-zatverdzhennjastandartu-medichnoi-dopomogi-zlojakisni-novoutvorennjatila-matki

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Published

2024-03-15

How to Cite

Bulavenko, O., Gromova, O., Dubossarska, Y., Ermolenko, T., Yefimenko, O., Zakharenko, N., Kosei, N., Pedachenko, N., Pyrohova, V., Rozhkovska, N., Tatarchuk, T., Tutchenko, T., & Yashina, O. (2024). Resolution of the II Ukrainian forum of experts on abnormal uterine bleeding. REPRODUCTIVE ENDOCRINOLOGY, (71), 20–28. https://doi.org/10.18370/2309-4117.2024.71.20-28

Issue

No. 71 (2024)

Section

Events

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Copyright (c) 2024 О.В. Булавенко, О.Л. Громова, Ю.О. Дубоссарська, Т.О. Єрмоленко, О.О. Єфіменко, Н.Ф. Захаренко, Н.В. Косей

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