Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction

Publication Date: July 2, 2013
Last Updated: March 14, 2022

Recommendations and Conclusions

The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

  • The levonorgestrel IUD has been shown to be effective in treating AUB and should be considered for all age groups.
  • Medical treatment options for AUB-O include progestin therapy and combined hormonal contraception.
  • Women who have completed childbearing, in whom medical therapy has failed, or who have contraindications to medical therapy are candidates for hysterectomy without cervical preservation.
  • Because AUB-O is an endocrinologic abnormality, the underlying disorder should be treated medically rather than surgically. Surgical therapy is rarely indicated for the treatment of AUB-O, unless medical therapy fails, is contraindicated, is not tolerated by the patient, or the patient has concomitant significant intracavitary lesions.
( B )

The following recommendations and conclusions are based primarily on consensus and expert opinion.

  • Failure of medical management requires further investigation, including imaging or hysteroscopy.
  • The choice of treatment of AUB-O is guided by the goals of therapy, which may be to stop acute bleeding, avoid future irregular or heavy bleeding, simultaneously provide contraception, and prevent complications, such as anemia, unnecessary surgical intervention, and diminished quality of life.
  • Endometrial ablation is not recommended as a firstline therapy for AUB-O. Physicians must provide thorough informed consent and adequate counseling to women with AUB-O who desire endometrial ablation.

Recommendation Grading




Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction

Authoring Organization

Publication Month/Year

July 2, 2013

Last Updated Month/Year

April 5, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adult

Health Care Settings


Intended Users

Physician, nurse, nurse practitioner, physician assistant


Management, Treatment

Diseases/Conditions (MeSH)

D014592 - Uterine Hemorrhage


abnormal uterine bleeding, uterine bleeding, ovulatory dysfunction, AUB-O, anovulatory bleeding