Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/10/11/884 |
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| author | Chiara Belcaro Federica Scrimin Alessandro Mangogna Emanuele Filippo Galati Stefania Biffi Lorenzo Monasta Federico Romano Giuseppe Ricci |
| author_facet | Chiara Belcaro Federica Scrimin Alessandro Mangogna Emanuele Filippo Galati Stefania Biffi Lorenzo Monasta Federico Romano Giuseppe Ricci |
| author_sort | Chiara Belcaro |
| collection | DOAJ |
| description | Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (<i>n</i> = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination. |
| first_indexed | 2024-03-10T15:13:46Z |
| format | Article |
| id | doaj.art-4b3228ce6dc24c41923e6b8250729a70 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T15:13:46Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-4b3228ce6dc24c41923e6b8250729a702023-11-20T19:08:03ZengMDPI AGDiagnostics2075-44182020-10-01101188410.3390/diagnostics10110884Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine BleedingChiara Belcaro0Federica Scrimin1Alessandro Mangogna2Emanuele Filippo Galati3Stefania Biffi4Lorenzo Monasta5Federico Romano6Giuseppe Ricci7Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyDepartment of Obsterics and Gynaecology, University of Verona, 37134 Verona, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyInstitute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell’Istria 65/1, 34134 Trieste, ItalyAbnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (<i>n</i> = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.https://www.mdpi.com/2075-4418/10/11/884abnormal uterine bleedingdiagnostic criteriahysteroscopyreproductive and pre-menopausal ageendometrial cancer |
| spellingShingle | Chiara Belcaro Federica Scrimin Alessandro Mangogna Emanuele Filippo Galati Stefania Biffi Lorenzo Monasta Federico Romano Giuseppe Ricci Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding Diagnostics abnormal uterine bleeding diagnostic criteria hysteroscopy reproductive and pre-menopausal age endometrial cancer |
| title | Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding |
| title_full | Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding |
| title_fullStr | Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding |
| title_full_unstemmed | Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding |
| title_short | Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding |
| title_sort | comparison between different diagnostic strategies in low risk reproductive age and pre menopausal women presenting abnormal uterine bleeding |
| topic | abnormal uterine bleeding diagnostic criteria hysteroscopy reproductive and pre-menopausal age endometrial cancer |
| url | https://www.mdpi.com/2075-4418/10/11/884 |
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