2020 Hong Kong College of Obstetricians and Gynaecologists guideline on investigations of premenopausal women with abnormal uterine bleeding

Abstract

Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.

婦女停經前出現子宮異常出血是婦科的常見症狀，包括月經頻率、持續時間，規律性或流量異常，可能導致各種婦科惡性腫瘤。為了確定診斷，適當的病史和體格檢查是必須的。根據臨床情況可以進行全血檢查、甲狀腺功能檢查、凝血指數、衣原體檢查，宮頸塗片檢查和妊娠檢查。出現盆腔腫塊、體檢結果不合格、症狀持續或對醫療無反應時應進行超聲檢查。40歲或以上女性應進行Pipelle子宮內膜活檢。40歲以下女性如有子宮內膜癌、持續症狀或對藥物治療無反應等危險因素，應進行子宮內膜活檢以排除子宮內膜癌。宮腔鏡檢查或生理鹽水輸注宮腔造影比超聲對子宮內膜病變的診斷更為敏感。本文對以上建議提供詳細信息。