An International Perspective on Abnormal Uterine Bleeding

 

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Ian S. Fraser, M.D. Hilary O.D. Critchley, M.D. Malcolm G. Munro, M.D.

This series of eight articles on various aspects of abnormal uterine bleeding (AUB) is the result of several thousand man- and woman-hours of review of multiple clinical, scientific, and social issues around the broad topic of AUB. The process was initiated because of an increasing awareness of the poor and confused definitions of several of the traditional English-language terminologies, especially menorrhagia, metrorrhagia, and dysfunctional uterine bleeding. Over the past 6 to 7 years, many stakeholders have participated in three major workshops, numerous conferences, teleconferences, and other meetings leading to a series of publications, identification of key issues, and presentation of recommendations on terminologies, definitions, and classifications around AUB. The articles in this issue of Seminars distill into written word this exercise, and we are grateful to many colleagues for their valuable input.

This broad discussion process has revealed several gaps in our understanding of the phenomenon of AUB, especially those around cultural issues, patient-based complaints and outcomes, and the need to develop a detailed classification of causes, which should enhance clinical trial design, facilitate comparisons across studies, and improve clinical management. Patient-based issues that lead to presentation to a health professional are not well understood, but cultural determinants, perception, and tolerance are clearly important.

Several of the articles in this issue may be regarded as material for debate, which will be developed and reviewed through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group over the next 1 to 2 years. The authors welcome contributions to the debate. Contributions are particularly welcomed to the classification scheme for causes of AUB, the basis for a structured menstrual history, and the cultural basis of perception, investigation, and management of AUB in low-resource settings.