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Contraception and Reproductive Medicine

, 2:20

First Online: 24 July 2017Received: 19 May 2017Accepted: 07 July 2017


Heavy menstrual bleeding HMB is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d’Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.

KeywordsHeavy menstrual bleeding Abnormal uterine bleeding Tranexamic acid Combination hormonal contraceptives Non-steroidal anti-inflammatory drugs Danazol AbbreviationsAUBAbnormal uterine bleeding

CHCsCombination hormonal contraceptives

COX-2Progesterone withdrawal increases endometrial cyclooxygenase 2

DMPADepot medroxyprogesterone acetate

FIGOFederation Internationale de Gynecologie et d’Obstetrique

FSHFollicular stimulating hormone

GnRHGonadotropin-releasing hormone

HMBHeavy menstrual bleeding

IMBIntermenstrual bleeding

LHLuteinizing hormone


LNG-IUSLevonorgestrel-releasing intrauterine system

MBLMenstrual blood loss


MPAMedroxyprogesterone acetate

NETAOral norethindrone acetate

NSAIDsNon-steroidal anti-inflammatory drugs

PAPlasminogen activators

PAI-1Plasminogen activator inhibitor-1

PBACPictorial blood loss assessment chart

PGF2aProstaglandin E2 PGE2, and prostaglandin F2 alpha

PRMsProgesterone receptor modulators

TFTissue factor

TNF-alphaTumor necrosis factor alpha

tPATissue-type plasminogen activator

uPAUrokinase-type plasminogen activator

VEGFVascular endothelial growth factor

VTEVenous thromboembolism

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Autor: Intira Sriprasert - Tarita Pakrashi - Thomas Kimble - David F. Archer

Fuente: https://link.springer.com/

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