How should abnormal uterine bleeding be managed in people with bleeding disorders: a systematic review of the literature and thematic synthesis

Abstract

Abnormal uterine bleeding (AUB) describes any bleeding from the uterus that deviates from the norm in terms of regularity, duration, or volume. AUB is a common condition that can significantly affect quality of life. Although inherited bleeding disorders (IBDs) can cause heavy menstrual bleeding, there is no clear consensus on how AUB is best managed in those patients. This study aimed to address this knowledge gap using evidence based on clinical findings to define the best management of AUB in patients with IBD by conducting a systematic review of the literature. Searches were conducted for articles published from January 1, 2000, until May 6, 2024 in the Embase (PubMed), Medline, Scopus, Cochrane library, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature complete via the Elton B. Stephens Company databases. In total, 244 studies were assessed for eligibility based on inclusion and exclusion criteria. Included studies were appraised for risk of bias and quality assurance using the Newcastle Ottawa Scale, after which data was systematically coded to generate descriptive and analytical themes. Thirteen studies were included in the thematic synthesis, encompassing over 893 participants. Thematic synthesis identified hormonal treatments, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), to be largely effective in the symptom management of AUB in IBDs. Treatment of AUB patients with LNG-IUS, followed by tranexamic acid or 1-deamino-8-d-arginine vasopressin (DDAVP) commonly led to amenorrhea. The use of LNG-IUS as first-line therapy is recommended for those with AUB, followed by the use of combination therapy such as tranexamic acid and desmopressin. We identified the need to strengthen communication between specialists involved in the care of those with AUB and IBDs.