The primary diagnosis and treatment norms and referral recommendations for abnormal uterine bleeding with ovulatory dysfunction in the gynecological clinic of primary hospitals in western China_West China Medical Journal

Authors：

KONG Linglingli ^1,2,3 , DING Yan ⁴ , CHANG Qing ⁵ , LIU Hongwei ^1,2 , QIAO Lin ^1,2 , LIN Yi ⁶ , HUANG Hui ⁷ , LU Ping ⁸ , LI Jun ⁹ , FENG Yun ¹⁰ , TANG Li ¹¹ , XU Zhihong ¹² , ZHAO Qing ¹³ , CHEN Hui ^1,2,3 , QIAO Xiaoyong ^1,2,3 ,  XU Liangzhi ^1,2,3

1. Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, Chengdu, Sichuan 610041, P. R. China;
3. Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P. R. China;
5. Department of Obstetrics and Gynecology, the First Affiliated Hospital of Army Medical University (Southwest Hospital), Chongqing 400038, P. R. China;
6. Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing 401147, P. R. China;
7. Reproductive Medical Center, Maternal and Child Health Care Hospital of Guiyang City, Guiyang, Guizhou 550003, P. R. China;
8. Department of Obstetrics and Gynecology, Xinjiang Uiger Municipal People’s Hospital, Urumqi, Xinjiang 830001, P. R. China;
9. Department of Obstetrics and Gynecology, Fukang Hospital of Tibet Autonomous Region, Lhasa, Tibet 850000, P. R. China;
10. Department of Obstetrics and Gynecology, the First People’s Hospital of Yunnan Province, Kunming, Yunnan 650034, P. R. China;
11. Department of Reproductive Genetics, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P. R. China;
12. Department of Obstetrics and Gynecology, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;
13. Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Shehong County, Suining, Sichuan 629200, P. R. China;

Corresponding author：

XU Liangzhi, Email: liangzxu@126.com

Keywords：

Abnormal uterine bleeding; Ovulatory dysfunction; Primary hospitals; Two-way referral

DOI：

10.7507/1002-0179.202003325

Video：

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Abstract Full text Figures/Tables Video References Cited by

Abnormal uterine bleeding with ovulatory dysfunction (AUB-O) is a common reproductive endocrine disease with complex and variable clinical manifestations. This disease has a long course and large individual differences. Difficulties in diagnosis and treatment and nonstandardized management are common in primary hospitals. In order to improve the diagnosis and treatment efficiency of AUB-O in primary hospitals, the gynecological endocrinologists in western China proposed this primary diagnosis and treatment norms and referral recommendations for gynecological outpatient clinics in primary hospitals, including the key points of diagnosis, hemostasis and cycle adjustment strategies, adjuvant treatment, and the principle of two-way referral. In particular, individualized treatment recommendations were proposed for young adolescents and menopausal transition patients. This recommendations are expected to serve as an important reference for AUB-O diagnosis, treatment and two-way referral of primary hospitals in western China.

Citation： KONG Linglingli, DING Yan, CHANG Qing, LIU Hongwei, QIAO Lin, LIN Yi, HUANG Hui, LU Ping, LI Jun, FENG Yun, TANG Li, XU Zhihong, ZHAO Qing, CHEN Hui, QIAO Xiaoyong, XU Liangzhi. The primary diagnosis and treatment norms and referral recommendations for abnormal uterine bleeding with ovulatory dysfunction in the gynecological clinic of primary hospitals in western China. West China Medical Journal, 2020, 35(11): 1303-1310. doi: 10.7507/1002-0179.202003325 Copy

1.	Kelekci S, Kaya E, Alan M, et al. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril, 2005, 84(3): 682-686.
2.	Fraser IS, Critchley HO, Broder M, et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med, 2011, 29(5): 383-390.
3.	中华医学会妇产科学分会妇科内分泌学组. 异常子宫出血诊断与治疗指南. 中华妇产科杂志, 2014, 49(11): 801-806.
4.	Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet, 2011, 113(1): 3-13.
5.	陈璐, 王燕, 冯同富, 等. 门诊宫腔镜对10 565例异常子宫出血患者PALM-CORIN病因分类的应用. 现代妇产科进展, 2016, 25(9): 641-645.
6.	房梅芳, 吴春寒. 661例异常子宫出血病因分析及处理探讨. 南京医科大学学报(自然科学版), 2017, 37(10): 1310-1312.
7.	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, 97(31): e11457.
8.	江卫红, 徐娟, 林敏, 等. 女性不同时期异常子宫出血病因分析. 陕西医学杂志, 2018, 47(7): 849-851.
9.	张以文. FIGO关于月经异常相关术语的共识和异常子宫出血病因的新分类系统. 国际妇产科学杂志, 2013, 40(2): 105-107.
10.	Fraser IS, Critchley HO, Munro MG, et al. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril, 2007, 87(3): 466-476.
11.	Munro MG, Critchley HO, Fraser IS, et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril, 2011, 95(7): 2204-2208.
12.	Committee on Practice Bulletins—Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol, 2013, 122(1): 176-185.
13.	中华医学会妇产科学分会妇科内分泌学组. 排卵障碍性异常子宫出血诊治指南. 中华妇产科杂志, 2018, 53(12): 801-807.
14.	全国卫生产业企业管理协会妇幼健康产业分会生殖内分泌学组. 中国子宫内膜增生诊疗共识. 生殖医学杂志, 2017, 26(10): 957-960.
15.	Wiksten-Almströmer M, Hirschberg AL, Hagenfeldt K. Menstrual disorders and associated factors among adolescent girls visitinga youth clinic. Acta Obstet Gynecol Scand, 2007, 86(1): 65-72.
16.	American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol, 2013, 121(4): 891-896.
17.	Centers for Disease Control and Prevention (CDC). U S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep, 2010, 59(RR-4): 1-86.
18.	Munro MG, Mainor N, Basu R, et al. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol, 2006, 108(4): 924-929.
19.	Elmaoğulları S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol, 2018, 10(3): 191-197.
20.	Ahuja SP, Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol, 2010, 23(6 Suppl): S15-S21.
21.	Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol, 2017, 30(3): 335-340.
22.	Gray SH. Abnormal vaginal bleeding in the adolescent, in Emans, Laufer, Goldstein’s pediatric & adolescent gynecology. 6th ed. Philadelphia: Lippincott Willianms Health, 2012: 159.
23.	American College of Obstetricians and Gynecologists. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG committee opinion, number 785. Obstet Gynecol, 2019, 134(3): e71-e83.
24.	Mullins TL, Miller RJ, Mullins ES. Evaluation and management of adolescents with abnormal uterine bleeding. Pediatr Ann, 2015, 44(9): e218-e222.
25.	石红. 青春期月经异常. 中国实用妇科与产科杂志, 2010, 26(7): 498-500.
26.	Oner G, Muderris Ⅱ. A prospective randomized trial comparing low-dose ethinyl estradiol and drospirenone 24/4 combined oral contraceptive vs. ethinyl estradiol and drospirenone 21/7 combined oral contraceptive in the treatment of hirsutism. Contraception, 2011, 84(5): 508-511.
27.	Maloney JM, Dietze P Jr, Watson D, et al. A randomized controlled trial of a low-dose combined oral contraceptive containing 3 mg drospirenone plus 20 microg ethinylestradiol in the treatment of acne vulgaris: lesion counts, investigator ratings and subject self-assessment. J Drugs Dermatol, 2009, 8(9): 837-844.
28.	Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol, 2012, 120(1): 197-206.
29.	Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol, 2016, 214(1): 31-44.
30.	郁琦, 邓姗. 协和妇科内分泌手册. 北京: 人民卫生出版社, 2018: 60.
31.	李扬志, 谢梅青. 孕激素制剂分类及临床应用特点. 实用妇产科杂志, 2011, 27(1): 5-8.
32.	Momoeda M, Hayakawa M, Shimazaki Y, et al. Does the presence of coexisting diseases modulate the effectiveness of a low-dose estrogen/progestin, ethinylestradiol/drospirenone combination tablet in dysmenorrhea? Reanalysis of two randomized studies in Japanese women. Int J Womens Health, 2014, 6: 989-998.
33.	Jain S, Vaid NB, Narang Y, et al. A randomised controlled trial comparing the efficacy and side-effects of intravaginal ring (Nuvaring®) with combined oral hormonal preparation in dysfunctional uterine bleeding. J Clin Diagn Res, 2016, 10(3): QC21-QC24.
34.	Mueck AO, Seeger H, Rabe T. Hormonal contraception and risk of endometrial cancer: a systematic review. Endocr Relat Cancer, 2010, 17(4): R263-R271.
35.	Iversen L, Sivasubramaniam S, Lee AJ, et al. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol, 2017, 216(6): 580.e1-580.e9.
36.	Petta CA, Ferriani RA, Abrao MS, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod, 2005, 20(7): 1993-1998.
37.	Vilos GA, Tureanu V, Garcia M, et al. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invasive Gynecol, 2009, 16(4): 480-484.
38.	Mansour D. Modern management of abnormal uterine bleeding: the levonorgestrel intra-uterine system. Best Pract Res Clin Obstet Gynaecol, 2007, 21(6): 1007-1021.
39.	Kaunitz AM, Meredith S, Inki P, et al. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol, 2009, 113(5): 1104-1116.
40.	Bahamondes MV, Monteiro I, Castro S, et al. Prospective study of the forearm bone mineral density of long-term users of the levonorgestrel-releasing intrauterine system. Hum Reprod, 2010, 25(5): 1158-1164.
41.	Kayikcioglu F, Gunes M, Ozdegirmenci O, et al. Effects of levonorgestrel-releasing intrauterine system on glucose and lipid metabolism: a 1-year follow-up study. Contraception, 2006, 73(5): 528-531.
42.	Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev, 2005(4): CD002126.
43.	乔杰, 马彩虹, 刘嘉茵, 等. 辅助生殖促排卵药物治疗专家共识. 生殖与避孕, 2015, 35(4): 211-223.
44.	Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaecol, 1999, 106(7): 623-632.
45.	Yuk JS. The incidence rates of endometrial hyperplasia and endometrial cancer: a four-year population-based study. PeerJ, 2016, 4: e2374.
46.	中华医学会妇产科学分会绝经学组. 围绝经期异常子宫出血诊断和治疗专家共识. 中华妇产科杂志, 2018, 53(6): 396-401.
47.	Gaetke-Udager K, McLean K, Sciallis AP, et al. Diagnostic accuracy of ultrasound, contrast-enhanced CT, and conventional MRI for differentiating leiomyoma from leiomyosarcoma. Acad Radiol, 2016, 23(10): 1290-1297.
48.	American College of Obstetricians and Gynecologists. ACOG committee opinion No. 440: the role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol, 2009, 114(2 Pt 1): 409-411.
49.	中华医学会妇产科学分会绝经学组. 绝经期管理与激素补充治疗临床应用指南(2012版). 中华妇产科杂志, 2013, 48(10): 795-799.
50.	Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health, 2012, 4: 413-421.
51.	Srivaths LV, Dietrich JE, Yee DL, et al. Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study. J Pediatr Adolesc Gynecol, 2015, 28(4): 254-257.
52.	Ferenczy A. Pathophysiology of endometrial bleeding. Maturitas, 2003, 45(1): 1-14.
53.	Bofill Rodriguez M, Lethaby A, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev, 2019, 9(9): CD000400.
54.	Guzick DS, Wing R, Smith D, et al. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril, 1994, 61(4): 598-604.
55.	Endrikat JS, Milchev NP, Kapamadzija A, et al. Bleeding pattern, tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe, the Middle East and Canada. Contraception, 2009, 79(6): 428-432.
56.	张炜. 经间期出血的病因与诊治. 实用妇产科杂志, 2016, 32(12): 887-890.

1. Kelekci S, Kaya E, Alan M, et al. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril, 2005, 84(3): 682-686.
2. Fraser IS, Critchley HO, Broder M, et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med, 2011, 29(5): 383-390.
3. 中华医学会妇产科学分会妇科内分泌学组. 异常子宫出血诊断与治疗指南. 中华妇产科杂志, 2014, 49(11): 801-806.
4. Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet, 2011, 113(1): 3-13.
5. 陈璐, 王燕, 冯同富, 等. 门诊宫腔镜对10 565例异常子宫出血患者PALM-CORIN病因分类的应用. 现代妇产科进展, 2016, 25(9): 641-645.
6. 房梅芳, 吴春寒. 661例异常子宫出血病因分析及处理探讨. 南京医科大学学报(自然科学版), 2017, 37(10): 1310-1312.
7. 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, 97(31): e11457.
8. 江卫红, 徐娟, 林敏, 等. 女性不同时期异常子宫出血病因分析. 陕西医学杂志, 2018, 47(7): 849-851.
9. 张以文. FIGO关于月经异常相关术语的共识和异常子宫出血病因的新分类系统. 国际妇产科学杂志, 2013, 40(2): 105-107.
10. Fraser IS, Critchley HO, Munro MG, et al. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril, 2007, 87(3): 466-476.
11. Munro MG, Critchley HO, Fraser IS, et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril, 2011, 95(7): 2204-2208.
12. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol, 2013, 122(1): 176-185.
13. 中华医学会妇产科学分会妇科内分泌学组. 排卵障碍性异常子宫出血诊治指南. 中华妇产科杂志, 2018, 53(12): 801-807.
14. 全国卫生产业企业管理协会妇幼健康产业分会生殖内分泌学组. 中国子宫内膜增生诊疗共识. 生殖医学杂志, 2017, 26(10): 957-960.
15. Wiksten-Almströmer M, Hirschberg AL, Hagenfeldt K. Menstrual disorders and associated factors among adolescent girls visitinga youth clinic. Acta Obstet Gynecol Scand, 2007, 86(1): 65-72.
16. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol, 2013, 121(4): 891-896.
17. Centers for Disease Control and Prevention (CDC). U S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep, 2010, 59(RR-4): 1-86.
18. Munro MG, Mainor N, Basu R, et al. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol, 2006, 108(4): 924-929.
19. Elmaoğulları S, Aycan Z. Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol, 2018, 10(3): 191-197.
20. Ahuja SP, Hertweck SP. Overview of bleeding disorders in adolescent females with menorrhagia. J Pediatr Adolesc Gynecol, 2010, 23(6 Suppl): S15-S21.
21. Haamid F, Sass AE, Dietrich JE. Heavy menstrual bleeding in adolescents. J Pediatr Adolesc Gynecol, 2017, 30(3): 335-340.
22. Gray SH. Abnormal vaginal bleeding in the adolescent, in Emans, Laufer, Goldstein’s pediatric & adolescent gynecology. 6th ed. Philadelphia: Lippincott Willianms Health, 2012: 159.
23. American College of Obstetricians and Gynecologists. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG committee opinion, number 785. Obstet Gynecol, 2019, 134(3): e71-e83.
24. Mullins TL, Miller RJ, Mullins ES. Evaluation and management of adolescents with abnormal uterine bleeding. Pediatr Ann, 2015, 44(9): e218-e222.
25. 石红. 青春期月经异常. 中国实用妇科与产科杂志, 2010, 26(7): 498-500.
26. Oner G, Muderris Ⅱ. A prospective randomized trial comparing low-dose ethinyl estradiol and drospirenone 24/4 combined oral contraceptive vs. ethinyl estradiol and drospirenone 21/7 combined oral contraceptive in the treatment of hirsutism. Contraception, 2011, 84(5): 508-511.
27. Maloney JM, Dietze P Jr, Watson D, et al. A randomized controlled trial of a low-dose combined oral contraceptive containing 3 mg drospirenone plus 20 microg ethinylestradiol in the treatment of acne vulgaris: lesion counts, investigator ratings and subject self-assessment. J Drugs Dermatol, 2009, 8(9): 837-844.
28. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol, 2012, 120(1): 197-206.
29. Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol, 2016, 214(1): 31-44.
30. 郁琦, 邓姗. 协和妇科内分泌手册. 北京: 人民卫生出版社, 2018: 60.
31. 李扬志, 谢梅青. 孕激素制剂分类及临床应用特点. 实用妇产科杂志, 2011, 27(1): 5-8.
32. Momoeda M, Hayakawa M, Shimazaki Y, et al. Does the presence of coexisting diseases modulate the effectiveness of a low-dose estrogen/progestin, ethinylestradiol/drospirenone combination tablet in dysmenorrhea? Reanalysis of two randomized studies in Japanese women. Int J Womens Health, 2014, 6: 989-998.
33. Jain S, Vaid NB, Narang Y, et al. A randomised controlled trial comparing the efficacy and side-effects of intravaginal ring (Nuvaring®) with combined oral hormonal preparation in dysfunctional uterine bleeding. J Clin Diagn Res, 2016, 10(3): QC21-QC24.
34. Mueck AO, Seeger H, Rabe T. Hormonal contraception and risk of endometrial cancer: a systematic review. Endocr Relat Cancer, 2010, 17(4): R263-R271.
35. Iversen L, Sivasubramaniam S, Lee AJ, et al. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol, 2017, 216(6): 580.e1-580.e9.
36. Petta CA, Ferriani RA, Abrao MS, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod, 2005, 20(7): 1993-1998.
37. Vilos GA, Tureanu V, Garcia M, et al. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invasive Gynecol, 2009, 16(4): 480-484.
38. Mansour D. Modern management of abnormal uterine bleeding: the levonorgestrel intra-uterine system. Best Pract Res Clin Obstet Gynaecol, 2007, 21(6): 1007-1021.
39. Kaunitz AM, Meredith S, Inki P, et al. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol, 2009, 113(5): 1104-1116.
40. Bahamondes MV, Monteiro I, Castro S, et al. Prospective study of the forearm bone mineral density of long-term users of the levonorgestrel-releasing intrauterine system. Hum Reprod, 2010, 25(5): 1158-1164.
41. Kayikcioglu F, Gunes M, Ozdegirmenci O, et al. Effects of levonorgestrel-releasing intrauterine system on glucose and lipid metabolism: a 1-year follow-up study. Contraception, 2006, 73(5): 528-531.
42. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev, 2005(4): CD002126.
43. 乔杰, 马彩虹, 刘嘉茵, 等. 辅助生殖促排卵药物治疗专家共识. 生殖与避孕, 2015, 35(4): 211-223.
44. Spencer CP, Whitehead MI. Endometrial assessment re-visited. Br J Obstet Gynaecol, 1999, 106(7): 623-632.
45. Yuk JS. The incidence rates of endometrial hyperplasia and endometrial cancer: a four-year population-based study. PeerJ, 2016, 4: e2374.
46. 中华医学会妇产科学分会绝经学组. 围绝经期异常子宫出血诊断和治疗专家共识. 中华妇产科杂志, 2018, 53(6): 396-401.
47. Gaetke-Udager K, McLean K, Sciallis AP, et al. Diagnostic accuracy of ultrasound, contrast-enhanced CT, and conventional MRI for differentiating leiomyoma from leiomyosarcoma. Acad Radiol, 2016, 23(10): 1290-1297.
48. American College of Obstetricians and Gynecologists. ACOG committee opinion No. 440: the role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. Obstet Gynecol, 2009, 114(2 Pt 1): 409-411.
49. 中华医学会妇产科学分会绝经学组. 绝经期管理与激素补充治疗临床应用指南(2012版). 中华妇产科杂志, 2013, 48(10): 795-799.
50. Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health, 2012, 4: 413-421.
51. Srivaths LV, Dietrich JE, Yee DL, et al. Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study. J Pediatr Adolesc Gynecol, 2015, 28(4): 254-257.
52. Ferenczy A. Pathophysiology of endometrial bleeding. Maturitas, 2003, 45(1): 1-14.
53. Bofill Rodriguez M, Lethaby A, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev, 2019, 9(9): CD000400.
54. Guzick DS, Wing R, Smith D, et al. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril, 1994, 61(4): 598-604.
55. Endrikat JS, Milchev NP, Kapamadzija A, et al. Bleeding pattern, tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe, the Middle East and Canada. Contraception, 2009, 79(6): 428-432.
56. 张炜. 经间期出血的病因与诊治. 实用妇产科杂志, 2016, 32(12): 887-890.

West China Medical Journal

The primary diagnosis and treatment norms and referral recommendations for abnormal uterine bleeding with ovulatory dysfunction in the gynecological clinic of primary hospitals in western China

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