ACTIVITY NUMBER:  RES006

ACTIVITY TITLE: Abnormal Uterine Bleeding

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  June 15, 2013

Reviewed and Updated 2018

Expiration Date: April 30, 2021

Under Review June 2022

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Abnormal menstrual bleeding is one of the most common problems seen by gynecologists and primary care physicians in office practice.  Up to 30% of women are affected at some time during their reproductive years by heavy menstrual bleeding, and abnormal uterine bleeding (AUB) impacts quality of life, productivity, and health care use and costs.  Clinical practice can be hindered by several factors. The diagnosis and evaluation of AUB is typically based on a woman’s personal assessment of her blood loss and its impact on her quality of life.  In addition, there is confusion over appropriate terminology in the medical literature. This has led to difficulties in interpreting results of clinical trials of new therapies and surgical procedures and in understanding studies investigating underlying mechanisms of bleeding.

This educational activity addresses the appropriate terminology of AUB, and identifies methods for patient communication and assessment to determine causal mechanisms and successfully treat this condition.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.      Describe the principal causes of abnormal uterine bleeding and the International Federation of Gynecology and Obstetrics (FIGO) classification system.

2.      Elicit a pertinent medical history to evaluate abnormal uterine bleeding.

3.      List the essential elements of a focused physical examination to investigate the etiology of abnormal uterine bleeding.

4.      List and interpret initial laboratory and diagnostic tests to evaluate heavy menstrual bleeding.

5.      Interpret the results of selected diagnostic tests to determine the cause of abnormal uterine bleeding.

6.      Identify treatments of abnormal uterine bleeding using nonsurgical and surgical methods.

7.      Describe the psychosocial impact of abnormal uterine bleeding and effective interventions.

8.      Recommend appropriate follow-up that is necessary for a patient with abnormal uterine bleeding.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·        View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·        Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

·        Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·        Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD – Nothing to Disclose

Valerie Baker, MD – Institutional Support from IBSA

Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk

Marcelle I. Cedars, MD – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Patricia M. McShane, MD – Consultant, World Egg Bank

Shona C. Murray, MD - Consultant, World Egg Bank

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Genevieve Neal-Perry, MD, PhD – Nothing to Disclose

Linda R. Nelson, MD, PhD – Nothing to Disclose

Lubna Pal, MBBS, MS – Research grant from Ferring

Staci E. Pollack, MD – Nothing to Disclose

Robert W. Rebar, MD – Nothing to Disclose

Richard H. Reindollar, MD – Nothing to Disclose

Randal Robinson, MD – Nothing to Disclose
Rhonda Ruiz – Nothing to Disclose

Nanette Santoro, MD – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc – Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.