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Review
. 2022 May 9;12(5):1176.
doi: 10.3390/diagnostics12051176.

Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality

Salvatore Giovanni Vitale  1 , Rafał Watrowski  2 , Fabio Barra  3 , Maurizio Nicola D'Alterio  4 , Jose Carugno  5 , Thozhukat Sathyapalan  6 , Ilker Kahramanoglu  7 , Enrique Reyes-Muñoz  8 , Li-Te Lin  9   10   11 , Bulent Urman  12   13 , Simone Ferrero  3 , Stefano Angioni  4
Affiliations
Review

Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality

Salvatore Giovanni Vitale et al. Diagnostics (Basel). .

Abstract

Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman's quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.

Keywords: abnormal uterine bleeding; hysteroscopy; perimenopause; quality of life; sexuality.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
FIGO classification of abnormal uterine bleeding. Adapted from [8].
Figure 2
Figure 2
Pedunculate low-risk endometrial polyp in the posterior uterine wall during diagnostic hysteroscopy (intraoperative picture by F.B. and S.F.).
Figure 3
Figure 3
Ultrasonographic appearance of uterine lesion suspected for early-stage endometrial cancer (A). The diagnostic hysteroscopic allows for visualizing the suspected uterine area (B) and for obtaining the histologic biopsy (C,D). Intraoperative photographs by F.B. and S.F.
Figure 4
Figure 4
Operative hysteroscopic removal of an endometrial polyp (mean diameter 13 mm) by Versapoint system (Gynecare, Ethicon Inc., Raritan, NJ, USA). Intraoperative photographs by F.B. and S.F.
See this image and copyright information in PMC

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