AUB-E refers to abnormal uterine bleeding originating from localized abnormalities of the endometrium. When AUB occurs in regular, ovulatory cycles and no other identifiable cause can be determined following thorough evaluation, it is considered likely to be caused by localized endometrial abnormalities.
Clinical Manifestations
Clinical presentations may include heavy menstrual bleeding, intermenstrual bleeding, or prolonged menstruation. The underlying mechanisms may involve abnormal regulation of endometrial coagulation and fibrinolysis, impaired endometrial repair mechanisms (such as endometrial inflammation, infection, or inflammatory responses), and abnormal endometrial angiogenesis.
Diagnosis
Currently, there is no specific method for diagnosing localized endometrial abnormalities. Diagnosis is primarily made by exclusion, relying on the elimination of other potential causes within the context of ovulatory cycles. Diagnostic tools, including hysteroscopy, pathological examination, and immunohistochemical testing for CD138, may enhance diagnostic accuracy.
Treatment
If endometritis is present, antibiotic therapy should be selected based on the results of endometrial microbial cultures. Empirical treatments often involve broad-spectrum antibiotics, such as doxycycline administered at a dosage of 0.1 g twice daily for 10–14 days.
Management of associated heavy menstrual bleeding includes the following approaches:
- Levonorgestrel-releasing intrauterine system (LNG-IUS): Suitable for individuals without fertility requirements for approximately one year.
- Antifibrinolytic therapy or nonsteroidal anti-inflammatory drugs (NSAIDs): Appropriate for individuals who are unwilling or unable to use hormonal therapy or those intending to conceive in the near future.
- Short-acting oral contraceptives.
- Progestin-induced endometrial atrophy therapy: Options include dydrogesterone at 20 mg once or twice daily, or norethisterone at 5 mg three times daily, starting on the fifth day of the menstrual cycle and continuing for 21 days.
Curettage is reserved for emergency hemostasis and pathological evaluation. For individuals who fail to respond to treatment and do not wish to preserve fertility, conservative surgical interventions such as endometrial ablation may be considered.