12 Future research into abnormal uterine bleeding Nadia C. Samuel MRCOG Research Fellow Department of Obstetrics & Gynaecology, Birmingham Women’s Hospital, Birmingham B15 2TG, UK T. Justin Clark * MD, MRCOG Consultant Obstetrician and Gynaecologist Department of Obstetrics & Gynaecology, Birmingham Women’s Hospital, Birmingham B15 2TG, UK Abnormal uterine bleeding in terms of menstrual disorders and postmenopausal bleeding are common clinical problems in both primary and secondary care. Advances in diagnostic and ther- apeutic technologies have offered opportunities to improve the outcomes of women suffering with these complaints. Future research should concentrate on a robust approach to the assess- ment of these health technologies, including the use of outcome assessments of importance to patients such as effects on health-related quality of life and taking account of patient preferences. In addition, economic evaluations need to be conducted alongside clinical research to facilitate a rational basis on which to allocate resources and upon which to base clinical decisions. Specific areas highlighted for research in this review include the role of diagnostic technologies incorpo- rating the clinical context within which diagnostic work-up takes place. The clinical application of progesterone antagonists and selective progesterone receptor modulators is a developing area with potential for the treatment of menorrhagia. The place of minimally invasive therapies for the treatment of menstrual dysfunction and fibroid-associated menorrhagia needs more examination, as does the place of outpatient ‘ambulatory’ settings to provide convenient, effec- tive ‘see and treat’ targeted services in both primary and secondary care. Key words: abnormal uterine bleeding; cost-effectiveness; diagnosis; effectiveness; fibroids; menorrhagia; research. * Corresponding author. Tel.: þ44 121 607 4712; Fax: þ44 121 627 2667. E-mail address: justin.clark@bwhct.nhs.uk (T. Justin Clark). 1521-6934/$ - see front matter ª 2007 Elsevier Ltd. All rights reserved. Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 21, No. 6, pp. 1023–1040, 2007 doi:10.1016/j.bpobgyn.2007.03.018 available online at http://www.sciencedirect.com