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Selmi C, La Marca A. Oral hormonal therapy as treatment option for abnormal uterine bleeding. EUR J CONTRACEP REPR 2023; 28:285-294. [PMID: 37955241 DOI: 10.1080/13625187.2023.2270098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND abnormal uterine bleeding is a very frequent reason for referral to gynaecologists and can deeply influence the quality of life. Once organic causes requiring surgical treatment are ruled out, clinicians should be able to manage these patients conservatively in the most effective way. MATERIALS AND METHODS a search in PubMed/MEDLINE database was conducted in order to find relevant and recent meaningful sources for this narrative review. RESULTS LNG-IUS 52 mg is the first-line treatment for non-organic causes. Nevertheless, it could be contraindicated or declined by the patient. Combined oral contraceptives (COC) and progestin-only pills inhibit the hypothalamic-pituitary-ovarian axis, preventing ovulation, and induce endometrial atrophy. Consequently, they are effective in treating AUB. Moreover, brand new pills containing a combination of oestrogens, progestins and GnRH antagonists are now available for the management of AUB related to uterine fibroids. CONCLUSIONS In daily clinical practice, oral hormonal therapies are convenient and reversible tools to manage AUB when LNG-IUS 52 mg is contraindicated or turn down by the patient. Many oral hormonal therapies are prescribed to treat AUB, but only a few have been approved with this specific indication, therefore further large well-designed studies are necessary in order to compare the efficacy of different pills for treating AUB.
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Affiliation(s)
- Chiara Selmi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Creinin MD, Barnhart KT, Gawron LM, Eisenberg D, Mabey RG, Jensen JT. Heavy Menstrual Bleeding Treatment With a Levonorgestrel 52-mg Intrauterine Device. Obstet Gynecol 2023; 141:971-978. [PMID: 37023455 PMCID: PMC10108838 DOI: 10.1097/aog.0000000000005137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/12/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate heavy menstrual bleeding treatment outcomes with levonorgestrel 52-mg intrauterine device (IUD) use in participants without body mass index (BMI) or parity restrictions. METHODS Investigators included participants aged 18-50 years with no pelvic or systemic pathology causing heavy menstrual bleeding at 29 U.S. centers in a prospective trial. Participants had up to three screening cycles with menstrual product collection for alkaline hematin blood-loss measurements. Investigators enrolled those with two menses with blood loss of 80 mL or more (values averaged for baseline blood loss), placed the IUD, and followed participants for up to six 28-day cycles. Participants collected any menstrual products used during cycles 3 and 6 for blood-loss measurement. We evaluated outcomes in participants with at least one follow-up assessment for the primary outcome of median absolute blood-loss change and, secondarily, treatment success, defined as the proportion with a final measured blood loss less than 80 mL and at least 50% reduction from baseline. We evaluated exploratory outcomes of differences in blood-loss changes by BMI and parity using Wilcoxon rank sum test. RESULTS Of 105 enrolled participants, 47 (44.8%) had obesity (BMI 30.0 or higher) and 29 (27.6%) were nulliparous. Baseline mean blood loss ranged from 73 to 520 mL (median 143 mL, interquartile range 112-196 mL). Eighty-nine (84.8%) had at least one evaluable follow-up evaluation. Participants had median (interquartile range) absolute blood-loss decreases at cycles 3 (n=86) and 6 (n=81) of 93.3% (86.1-97.7%) and 97.6% (90.4-100%), respectively. At cycle 6, participants without obesity (n=43) and with obesity (n=38) had similar median [interquartile range] decreases (97.6% [91.8-100%] and 97.5% [90.3-100%], respectively; P=.89), with comparable findings for nulliparous (n=25) and parous (n=56) participants (97.0% [91.7-99.1%] and 98.1% [89.9-100%], respectively; P=.43). Treatment success occurred in 81.8% (95% CI 74.2-89.4%) of 99 participants, excluding those with no outcomes due to lost to follow-up or consent withdrawal, and did not vary by BMI or parity. The most common adverse events leading to discontinuation were bleeding or cramping (n=6 [5.7%]) and expulsion (n=5 [4.8%]). CONCLUSION This levonorgestrel 52-mg IUD reduces blood loss by more than 90% over 6 months compared with baseline for most users with heavy menstrual bleeding. FUNDING SOURCE Medicines360. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03642210.
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Affiliation(s)
- Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California; the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; Las Vegas, Nevada; and the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Depes DDB, Mata MVMD, Pereira AMG, Martins JA, Araújo MPD, Lopes RGC, Bella ZIKDJD. Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri. EINSTEIN-SAO PAULO 2023; 21:eAO0033. [PMID: 37075458 PMCID: PMC10118365 DOI: 10.31744/einstein_journal/2023ao0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 10/16/2022] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE The levonorgestrel intrauterine system treatment prevents 67.7% of surgeries in patients with heavy menstrual bleeding and enlarged uteri. To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. METHODS This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2. RESULTS In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00). CONCLUSION Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.
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Curry N, Bowles L, Clark TJ, Lowe G, Mainwaring J, Mangles S, Myers B, Kadir RA. Gynaecological management of women with inherited bleeding disorders. Haemophilia 2022; 28:917-937. [PMID: 35976756 DOI: 10.1111/hae.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 12/17/2022]
Abstract
Women with inherited bleeding disorders (IBDs) may present to healthcare professionals in a variety of ways and commonly will be encountered by either haematology or gynaecology services. Heavy menstrual bleeding is very often the first manifestation of an IBD. There is a wide variation in severity of bleeding for women with IBD and diagnosis and subsequent management of their condition requires multidisciplinary specialised care which is tailored to the individual and includes excellent cross-specialty communication between gynaecology and haematology teams. This guideline is intended for both haematologists and gynaecologists who are involved in the diagnosis and management of women with bleeding disorders. It sets out recommendations about how to investigate heavy menstrual bleeding (HMB), the commonest presentation for women with IBD to hospital services, to guide physicians about how to diagnose an IBD and covers the management of women with known IBD and HMB. The second section sets out recommendations for patients known to have IBD and covers management of patients with IBD in the setting of gynaecological surgery and management for all other non-surgical gynaecological situations.
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Affiliation(s)
- Nicola Curry
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, and NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - Louise Bowles
- The Royal London Hospital Haemophilia Comprehensive Care Centre, The Royal London Hospital, Whitechapel, London, UK
| | - T Justin Clark
- Birmingham Women's NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Gillian Lowe
- West Midlands Comprehensive Care Haemophilia Unit, University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Jason Mainwaring
- Bournemouth and Poole Haemophilia Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, UK
| | - Sarah Mangles
- Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Bethan Myers
- Leicester Haemostasis and Thrombosis Centre, University Hospitals of Leicester, Leicester, UK
| | - Rezan Abdul Kadir
- Department of Obstetrics and Gynaecology, Katharine Dormandy Haemophilia and Thrombosis Unit, The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
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Lindh I, Skjeldestad FE, Heikinheimo O, Hognert H, Lidegaard Ø, Bergh C, Gemzell-Danielsson K. Reproductive changes among women in their 40s: A cross-sectional study. Acta Obstet Gynecol Scand 2022; 101:248-255. [PMID: 34988971 DOI: 10.1111/aogs.14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim was to describe and compare changes in the reproductive pattern of women in their 40s observed over a decade in Scandinavia. MATERIAL AND METHODS Cross-sectional study using the total population of women aged 40-49 years between 2008-2018 in Denmark, Norway and Sweden (on average n = 1.5 million). Aggregated data concerning birth and induced abortion rate were collected and analyzed from national health registers. National data on redeemed prescriptions of hormonal contraceptives in the three countries were collected from prescription registers. Births after spontaneous and assisted conceptions were identified by using cross-linked data on deliveries from the Medical Birth Registers and National Registers of Assisted Reproduction in the three countries. RESULTS Use of hormonal contraception increased among women aged 40-44 years in Denmark from 24% to 31%, in Sweden from 27% to 30%, and in Norway from 22% to 24%. The levonorgestrel-releasing intrauterine device was the most frequently used method in all countries. Birth rates among women 40-44 years increased continuously from 9.5 to 12/1000 women in Denmark and from 11.7 to 14.3/1000 in Sweden, but remained stable in Norway at ~11/1000 women. There was a doubling of assisted conceptions in Denmark from 0.71 to 1.71/1000 women, Sweden from 0.43 to 0.81/1000 and Norway from 0.25 to 0.53/1000 women 40-49 years of age. Sweden had the highest induced abortion rate (7.7 to 8.1/1000 women) in women aged 40-49 years during the study period. CONCLUSIONS From 2008 to 2018, birth rates continuously increased among women aged 40-49 years in Denmark and Sweden and births resulting from assisted reproductive technology doubled in all three countries.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden
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Dugan C, Scott C, Abeysiri S, Baikady RR, Richards T. The need to screen for anemia in exercising women. Medicine (Baltimore) 2021; 100:e27271. [PMID: 34596123 PMCID: PMC8483825 DOI: 10.1097/md.0000000000027271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Anemia is common, affecting 1 in 3 women in their lifetime. Despite high prevalence rates, awareness is poor. This is relevant for women undertaking sport as anemia can lead to reduced physical performance. There is no current screening program for testing of anemia for exercising women. Therefore, the objective of the present study was to assess a simple screening tool to predict anemia in exercising women.Cross sectional survey study.National fitness festival.Three hundred exercising women.Screening methodology (Female Health Questionnaire and a haemoglobin concentration measurement).The Female Health Questionnaire inquired about; previous iron status, menstrual blood loss, diet, and motherhood. Participants were asked to self-report any symptoms of iron deficiency, including; brain fog, palpitations, shortness of breath, restless legs, hair loss, and pica. Results were compared to fingerprick haemoglobin levels with anemia defined as [Hb] < 120 g/L.Average age was 31.21years (s.d.7.72), average [Hb] was 131.76 g/L (s.d.11.5) and 36 (12%) had anemia. A history of iron deficiency was reported by 127 (43.49%), 127 (43.49%) reported heavy menstrual bleeding (HMB), 75 were vegetarian (18%) or vegan (8%) and 33 were mothers (11%). In total 80 reported taking time off work (total 1612 days). Women with anemia more commonly reported HMB (58.33% vs. 41.57%, P = .04), and those with HMB were more likely to report days off (39.37% vs. 18.18%, P < .001).Anemia was common in exercising women, particularly those with HMB. A simple screening tool for HMB and finger prick haemoglobin testing for anemia is recommended in women undertaking exercise.
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Affiliation(s)
- Cory Dugan
- Division of Surgery, University of Western Australia, Perth
| | | | | | - Ravishankar Rao Baikady
- The Iron Clinic, London, UK
- Department of Anesthesia and Peri Operative Medicine, The Royal Marsden NHS Foundation Trust, Dept, London, UK
| | - Toby Richards
- Division of Surgery, University of Western Australia, Perth
- The Iron Clinic, London, UK
- Department of Anesthesia and Peri Operative Medicine, The Royal Marsden NHS Foundation Trust, Dept, London, UK
- Lawrence-Brown Chair in Vascular Surgery, Division of Surgery, University of Western Australia, Perth
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Joo JK, Shin JH, Lee JR, Kim MR. Levonorgestrel-Releasing Intrauterine System Use in Perimenopausal Women. J Menopausal Med 2021; 27:49-57. [PMID: 34463068 PMCID: PMC8408317 DOI: 10.6118/jmm.20038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/06/2021] [Accepted: 06/08/2021] [Indexed: 12/28/2022] Open
Abstract
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive method that has several noncontraceptive benefits. It has been used in various gynecological conditions, such as heavy menstrual bleeding, dysmenorrhea, and endometrial hyperplasia. During the perimenopausal period, hormonal fluctuations occur, and there is a high tendency for the development of several benign gynecologic diseases. Therefore, the use of LNG-IUS in perimenopausal women might be more beneficial than in women belonging to other age groups. Moreover, the insertion of LNG-IUS during the perimenopausal period could confer endometrial protection during estrogen replacement therapy. In this review, we discuss the use of LNG-IUS in perimenopausal women.
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Affiliation(s)
- Jong-Kil Joo
- Department of Obstetrics and Gynecology, College of Medicine, Pusan National University, Busan, Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Donnez J. Uterine Fibroids and Progestogen Treatment: Lack of Evidence of Its Efficacy: A Review. J Clin Med 2020; 9:jcm9123948. [PMID: 33291422 PMCID: PMC7762035 DOI: 10.3390/jcm9123948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The objective of this review is to determine the evidence or, conversely, the absence of evidence regarding the effectiveness of progestogens in treating premenopausal women with uterine fibroids. In particular, the goal is to address recurring questions as to whether they are effective or not for managing symptoms commonly attributed to fibroids. METHODS A review of the most relevant papers (n = 63) on the efficacy of progesterone and progestogens as medical therapy for uterine fibroids. RESULTS Having reviewed the most significant papers on the relationship between uterine fibroids and progesterone/progestogens, it is clear that there is biochemical, histological and clinical evidence that progesterone and progestogens play a critical role in the pathogenesis of myomas. CONCLUSION Since progesterone is already implicated in the pathogenesis of this entity, using progestogens to manage fibroids is like constantly adding fuel to the fire, rendering this treatment ineffective.
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Affiliation(s)
- Jacques Donnez
- Société de Recherche pour l’Infertilité (SRI), 1150 Brussels, Belgium;
- Université Catholique de Louvain, 1200 Brussels, Belgium
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Tabachnik M, Sheiner E, Wainstock T. The association between second to fourth digit ratio, reproductive and general health among women: findings from an Israeli pregnancy cohort. Sci Rep 2020; 10:6341. [PMID: 32286380 PMCID: PMC7156723 DOI: 10.1038/s41598-020-62599-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/15/2020] [Indexed: 12/17/2022] Open
Abstract
The ratio between the length of second and fourth digits (2D:4D) is a putative biomarker for prenatal testosterone and estrogen exposure. The aim of the study was to examine the association between 2D:4D and women’s general and reproductive health. This analysis was conducted within a prospective pregnancy cohort study. The study population included 187 women. 2D:4D was measured directly in both hands using a digital caliper. Multivariable linear and logistic models were used to study the associations between digit ratio and the studied health characteristics. Mean age of the participants was 30.7 ± 4.9 years. The mean age at menarche was 12.9 ± 1.4 years. Right hand 2D:4D mean ± SD was 0.965 ± 0.03. Left hand 2D:4D mean ± SD was 0.956 ± 0.03. An association was found between right 2D:4D and age at menarche, with older age in women with 2D:4D ≥ mean versus 2D:4D < mean (13.2 ± 1.5 and 12.8 ± 1.3 respectively, b = 0.48, 95%CI:0.06–0.91) while controlling for ethnicity. Higher 2D:4D was also associated with heavier menses bleeding and dysmenorrhea. There is an association between 2D:4D and sub optimal reproductive characteristics, including later age at menarche, heavier menses bleeding and dysmenorrhea. These findings support the association between the intrauterine period and reproductive characteristics. Further studies are required to support our findings.
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Affiliation(s)
- Maya Tabachnik
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, 84101, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel
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Borzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr 2020; 174:186-194. [PMID: 31886837 DOI: 10.1001/jamapediatrics.2019.5040] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Heavy menstrual bleeding is a common cause of anemia and reduced quality of life in adolescents. There is a higher prevalence of bleeding disorders in girls with heavy menstrual bleeding than in the general population. Pediatricians should be comfortable with the initial evaluation of heavy menstrual bleeding and the indications for referral to subspecialty care. OBSERVATIONS The most common cause of heavy menstrual bleeding in adolescents is ovulatory dysfunction, followed by coagulopathies. The most common inherited bleeding disorder is von Willebrand disease, and its incidence in adolescents with heavy menstrual bleeding is high. Distinguishing the etiology of heavy menstrual bleeding will guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both. Among hormonal agents, the 52-mg levonogestrel intrauterine device has been shown to be superior in its effect on heavy menstrual bleeding and is safe and effective in adolescents with bleeding disorders. CONCLUSIONS AND RELEVANCE Anemia, need for transfusion of blood products, and hospitalization may be avoided with prompt recognition, diagnosis, and treatment of heavy menstrual bleeding, especially when in the setting of bleeding disorders. Safe and effective treatment methods are available and can greatly improve quality of life for affected adolescents. A multidisciplinary approach to the treatment of girls with bleeding disorders and history of heavy menstrual bleeding is optimal.
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Affiliation(s)
- Claudia Borzutzky
- Keck School of Medicine of University of Southern California, Los Angeles.,Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Julie Jaffray
- Keck School of Medicine of University of Southern California, Los Angeles.,Children's Center for Cancer and Blood Diseases, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is a menstrual blood loss perceived by women as excessive that affects the health of women of reproductive age, interfering with their physical, emotional, social and material quality of life. Whilst abnormal menstrual bleeding may be associated with underlying pathology, in the present context, HMB is defined as excessive menstrual bleeding in the absence of other systemic or gynaecological disease. The first-line therapy is usually medical, avoiding possibly unnecessary surgery. Of the wide variety of medications used to reduce HMB, oral progestogens were originally the most commonly prescribed agents. This review assesses the effectiveness of two different types and regimens of oral progestogens in reducing ovulatory HMB.This is the update of a Cochrane review last updated in 2007, and originally named "Effectiveness of cyclical progestagen therapy in reducing heavy menstrual bleeding" (1998). OBJECTIVES To determine the effectiveness, safety and tolerability of oral progestogen therapy taken either during the luteal phase (short cycle) or for a longer course of 21 days per cycle (long cycle), in achieving a reduction in menstrual blood loss in women of reproductive age with HMB. SEARCH METHODS In January 2019 we searched Cochrane Gynaecology and Fertility's specialized register, CENTRAL, MEDLINE, Embase, CINAHL and PsycInfo. We also searched trials registers, other sources of unpublished or grey literature and reference lists of retrieved trials. We also checked citation lists of review articles to identify trials. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing different treatments for HMB that included cyclical oral progestogens were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trials for risk of bias and extracted data. We contacted trial authors for clarification of methods or additional data when necessary. We only assessed adverse events if they were separately measured in the included trials. We compared cyclical oral progestogen in different regimens and placebo or other treatments. Our primary outcomes were menstrual blood loss and satisfaction with treatment; the secondary outcomes were number of days of bleeding, quality of life, compliance and acceptability of treatment, adverse events and costs. MAIN RESULTS This review identified 15 randomized controlled trials (RCTs) with 1071 women in total. Most of the women knew which treatment they were receiving, which may have influenced their judgements about menstrual blood loss and satisfaction. Other aspects of trial quality varied among trials.We did not identify any RCTs comparing progestogen treatment with placebo. We assessed comparisons between oral progestogens and other medical therapies separately according to different regimens.Short-cycle progestogen therapy during the luteal phase (medroxyprogesterone acetate or norethisterone for 7 to 10 days, from day 15 to 19) was inferior to other medical therapy, including tranexamic acid, danazol and the progestogen-releasing intrauterine system (Pg-IUS (off of the market since 2001)), releasing 60 mcg of progesterone daily, with respect to reduction of menstrual blood loss (mean difference (MD) 37.29, 95% confidence interval (CI) 17.67 to 56.91; I2 = 50%; 6 trials, 145 women). The rate of satisfaction and the quality of life with treatment was similar in both groups. The number of bleeding days was greater on the short cycle progestogen group compared to other medical treatments. Adverse events (such as gastrointestinal symptoms and weight gain) were more likely with danazol when compared with progestogen treatment. We note that danazol is no longer in general use for treating HMB.Long-cycle progestogen therapy (medroxyprogesterone acetate or norethisterone), from day 5 to day 26 of the menstrual cycle, is also inferior to the levonorgestrel-releasing intrauterine system (LNG-IUS), releasing tranexamic acid and ormeloxifene, but may be similar to the combined vaginal ring with respect to reduction of menstrual blood loss (MD 16.88, 95% CI 10.93 to 22.84; I2 = 87%; 4 trials, 355 women). A higher proportion of women taking norethisterone found their treatment unacceptable compared to women having Pg-IUS (Peto odds ratio (OR) 0.12, 95% CI 0.03 to 0.40; 1 trial, 40 women). However, the adverse effects of breast tenderness and intermenstrual bleeding were more likely in women with the LNG-IUS. No trials reported on days of bleeding or quality of life for this comparison.The evidence supporting these findings was limited by low or very low gradings of quality; thus, we are uncertain about the findings and there is a potential that they may change if we identify other trials. AUTHORS' CONCLUSIONS Low- or very low-quality evidence suggests that short-course progestogen was inferior to other medical therapy, including tranexamic acid, danazol and the Pg-IUS with respect to reduction of menstrual blood loss. Long cycle progestogen therapy (medroxyprogesterone acetate or norethisterone) was also inferior to the LNG-IUS, tranexamic acid and ormeloxifene, but may be similar to the combined vaginal ring with respect to reduction of menstrual blood loss.
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Affiliation(s)
| | - Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyPark RdGraftonAucklandNew Zealand1142
| | - Cindy Low
- The University of AucklandPark RdGraftonAucklandNew Zealand1142
| | - Iain T Cameron
- University of SouthamptonFaculty of MedicineSouth Academic Block, Mailpoint 801, Southampton General Hospital, Tremona RoadSouthamptonUKSO16 6YA
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Serfaty D, Bénézech JP, Heckel S, De Reilhac P. Consensus of best practice in intrauterine contraception in France. EUR J CONTRACEP REPR 2019; 24:305-313. [PMID: 31204843 DOI: 10.1080/13625187.2019.1625325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Our aim was to provide a consensus of best practice in intrauterine contraception (IUC) for French practitioners. Methods: A meeting of 38 gynaecologists was held to establish a consensus of best practice in IUC, using the validated nominal group (NG) method to reach consensus. Seventy questions were posed covering insertion, monitoring and removal of IUC devices. Two working groups were formed and all proposals were voted on, discussed and approved by the NG. Results: Of the 70 questions asked, answers to only four failed to reach NG consensus. While, in general, the IUC practices of French gynaecologists are in line with international guidelines, some notable differences were identified: for example, when to use the levonorgestrel-releasing intrauterine system versus the copper intrauterine device; practice recommendations in the event of upper genital tract infections; and immediate postpartum insertion. Clinicians are encouraged to inform women about IUC, irrespective of their age or parity. In general, the wishes and characteristics of the woman must be the main criteria informing the choice of IUC, once all potential contraindications have been excluded and information about IUC shared. Conclusions: This consensus paper is intended to update and standardise knowledge about IUC for health care professionals, to address any reticence about use of this contraceptive method.
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Affiliation(s)
| | | | - Sergine Heckel
- c Obstetrician Gynaecologist , Centre hospitalier Saint-Joseph et Saint-Luc , Lyon , France
| | - Pia De Reilhac
- d Obstetrician Gynaecologist , Place Paul Emile Ladmirault , Nantes , France
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Abstract
PURPOSE OF REVIEW This review highlights the complexity of caring for gynecologic patients who refuse blood transfusion and discusses the importance of early, targeted perioperative and intraoperative medical optimization. We review alternative interventions and the importance of medical management to minimize blood loss and maximize hematopoiesis, particularly in gynecologic patients who may have significant uterine bleeding. The review also focuses on intraoperative interventions and surgical techniques to prevent and control surgical blood loss. RECENT FINDINGS With improvements in surgical technique, greater availability of minimally invasive surgery, and increased use of preop UAE and cell salvage, definitive surgical management can be safely performed. New technologies have been developed that allow for safer surgeries or alternatives to traditional surgical procedures. Many medical therapies have been shown to decrease blood loss and improve surgical outcomes. Nonsurgical interventions have also been developed for use as adjuncts or alternatives to surgery. SUMMARY The care of a patient who declines blood transfusion may be complex, but gynecologic surgeons can safely and successfully offer a wide variety of therapies depending on the patient's goals and needs. Medical management should be implemented early. A multidisciplinary team should be mobilized to provide comprehensive and patient-centered care.
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Sergison JE, Maldonado LY, Gao X, Hubacher D. Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. Am J Obstet Gynecol 2019; 220:440-448.e8. [PMID: 30527945 PMCID: PMC6512461 DOI: 10.1016/j.ajog.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022]
Abstract
Objective Data Amenorrhea is a polarizing noncontraceptive effect of the levonorgestrel intrauterine system. Composite amenorrhea prevalence estimates that summarize all clinical data for the first-year after insertion currently are not available. The purpose of this study was to investigate the validity of existing prevalence estimates by the systematic calculation of amenorrhea measures for a general population of levonorgestrel intrauterine system users and to provide 90-day interval point estimates for the first year of use. Study We identified clinical trials, randomized controlled trials, and randomized comparative trials that were published in English between January 1970 and September 2017 through electronic searches of 12 biomedical and scientific literature databases that included MEDLINE and ClinicalTrials.gov. Study Appraisal and Synthesis Methods We considered studies that clearly defined amenorrhea per World Health Organization standards (the complete cessation of bleeding for at least 90 days), collected data from written daily bleeding diaries (the gold standard data collection technique on menstrual bleeding changes), and evaluated levonorgestrel intrauterine system devices that released 20 μg of levonorgestrel per day. We assessed study quality using guidelines established by the US Preventive Services Task Force and Cochrane handbook for systematic reviews of interventions. Two reviewers independently conducted all review stages; disagreements were resolved by a third reviewer. Where possible, data were pooled with the use of a random-effects model. Results Of 2938 potentially relevant studies, we included 9 in our meta-analysis. We calculated amenorrhea prevalence, which was weighted for inter- and intrastudy variance, for 4 90-day intervals and months 0–12. Our results demonstrated few levonorgestrel intrauterine system users (0.2%; 95% confidence interval, 0.0–0.4) experienced amenorrhea during the first 90 days after insertion; however, prevalence increased to 8.1% (95% confidence interval, 6.6–9.7) on days 91–180. Finally, 18.2% (95% confidence interval, 14.9–21.5) of users experienced amenorrhea for at least 1 90-day interval during the first year. Although interstudy heterogeneity limited reliability of days 181–271 and 272–365 measures, prevalence increased from 13.6% (95% confidence interval, 9.3–18.0) to 20.3% (95% confidence interval, 13.5–27.0), respectively. Conclusion Approximately 20% of levonorgestrel intrauterine system users experience amenorrhea during at least 1 90-day interval by the first year after insertion. This composite estimate is consistent with the product labeling and demonstrates that most users do not experience amenorrhea during the first year. These results provide accurate summary measures to facilitate counselling and informed method selection.
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Vakili F, Mirmohammadaliei M, Montazeri A, Farokhi M, Minaee MB. Impact of Hypericum Perforatum Ointment on Perineal Pain Intensity Following Episiotomy: a Randomized Placebo-Controlled Trial. J Caring Sci 2019; 7:205-211. [PMID: 30607361 PMCID: PMC6311625 DOI: 10.15171/jcs.2018.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction:The present study was conducted to evaluate
the effects of Hypericum Perforatum ointment on perineal pain intensity following
episiotomy among primiparous women. Methods This triple-blind clinical trial was performed on 98
eligible primiparous women referring to selected educational hospital of Tehran University
of Medical Sciences for normal vaginal delivery. Block Randomization (in 1; 1 ratio) was
used to categorize the participants continuously into two groups: intervention (using
Hypericum Perforatum ointment) and control (using placebo ointment). Participants in each
group used ointments (about 3 grams each time) on episiotomy site, twice a day and for a
period of ten days. Our primary outcome was the pain intensity in different intervals
following episiotomy. The data were analyzed by SPSS software (version 13) using student's
t test, Mann-Whitney U test and chi-square test. Results: We missed 14 participants during the study and
analyzed the data from 42 participants in each group. The mean of pain scores revealed no
significant differences before (mean difference=-0.33; P=0.46) and four hours (mean
difference=0.57; P=0.13) after ointments use, between the intervention and control groups,
while these differences were significant after eight hours (mean difference=2.17;
P<0.001), five days (mean difference=2.20; P<0.001) and ten days (mean
difference=2.21; P<0.001) following the intervention. Conclusion: Using Hypericum Perforatum ointment as a
noninvasive, simple and effective topical formulation, can significantly reduce pain
intensity of episiotomy site.
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Affiliation(s)
- Farzaneh Vakili
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Mirmohammadaliei
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Department of Mental Health, Institute of Health Sciences, Tehran, Iran
| | - Mina Farokhi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagher Minaee
- Department of Histology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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FSRH Guideline (January 2019) Combined Hormonal Contraception (Revision due by January 2024). BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-93. [PMID: 30665985 DOI: 10.1136/bmjsrh-2018-chc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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17
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Yu O, Scholes D, Schulze-Rath R, Grafton J, Hansen K, Reed SD. A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014. Am J Obstet Gynecol 2018; 219:591.e1-591.e8. [PMID: 30291840 DOI: 10.1016/j.ajog.2018.09.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite considerable public health burden, uterine fibroid population-based incidence estimates are few. Secular trends over time are even more limited. OBJECTIVE We sought to evaluate the incidence, 10-year secular trends, and prevalence of uterine fibroid diagnoses and describe the proportion of symptomatic women. STUDY DESIGN We performed a retrospective population-based cohort study of women, aged 18-65 years, enrolled 2005 through 2014 in Kaiser Permanente Washington. Uterine fibroid diagnoses identified by International Classification of Diseases, Ninth Revision codes and potential covariates were extracted from computerized databases. Women with prior hysterectomy and, for incidence estimates, women with prior fibroid diagnoses were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression models. Rates and trend tests were examined for all women, by age groups, and by race/ethnicity. RESULTS Associated International Classification of Diseases, Ninth Revision symptom-related codes were observed in 90% of incident cases. Incidence rates for fibroid diagnoses were highest for the age group 45-49 years, 240.3 per 10,000 woman-years in 2014, and for black women across all years. Overall age-adjusted estimated incidence rates declined during the 10-year study interval, from 139.4 per 10,000 woman-years in 2005 to 101.4 in 2014 (P value trend .0008). Overall prevalence in 2014 was 9.6%, and was highest among women aged 50-54 years (15.9%). Black women had higher prevalence (18.5%) than other racial/ethnic groups. CONCLUSION We found a decreasing trend of new uterine fibroid diagnoses among predominantly symptomatic women ages 18-65 years in a recent 10-year interval. This finding was due, perhaps in part, to secular trends of decreasing hysterectomies. Nonetheless, uterine fibroids remain a common health burden, with a prevalence of nearly 10%. Rates are disproportionately high and occur at younger ages for black women, and possibly for other non-white racial/ethnic groups. These findings are of concern, as current available long-term medical therapies remain limited.
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Philip CA, Le Mitouard M, Maillet L, de Saint-Hilaire P, Huissoud C, Cortet M, Dubernard G. Evaluation of NovaSure® global endometrial ablation in symptomatic adenomyosis: A longitudinal study with a 36 month follow-up. Eur J Obstet Gynecol Reprod Biol 2018; 227:46-51. [DOI: 10.1016/j.ejogrb.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
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Mullins ES, Miller RJ, Mullins TLK. Abnormal Uterine Bleeding in Adolescent Women. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2018; 51:119-137. [PMID: 29555380 DOI: 10.1016/j.bpobgyn.2018.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 12/15/2022]
Abstract
The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD). A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE). This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.
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Affiliation(s)
- Margit Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juhl Jensensvej 100, 8200 Aarhus N, Denmark.
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Brennan A, Hickey M. Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas. Med J Aust 2018; 208:90-95. [PMID: 29385977 DOI: 10.5694/mja17.00726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 01/30/2023]
Abstract
Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.
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Sriprasert I, Pakrashi T, Kimble T, Archer DF. Heavy menstrual bleeding diagnosis and medical management. Contracept Reprod Med 2017; 2:20. [PMID: 29201425 PMCID: PMC5683444 DOI: 10.1186/s40834-017-0047-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d’Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.
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Affiliation(s)
- Intira Sriprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tarita Pakrashi
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine/Eastern Virginia Medical School, Norfolk, VA USA
| | - Thomas Kimble
- CONRAD Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA USA
| | - David F Archer
- CONRAD Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA USA
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24
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Heikinheimo O, Fraser I. The current status of hormonal therapies for heavy menstrual bleeding. Best Pract Res Clin Obstet Gynaecol 2017; 40:111-120. [PMID: 28238590 DOI: 10.1016/j.bpobgyn.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 11/24/2022]
Abstract
Hormonal treatment of abnormal uterine bleeding (AUB), especially bleeding related to endometrial causes (AUB-E), ovulatory dysfunction (AUB-O) and coagulopathy (AUB-C), and to some extent, uterine leiomyomas and adenomyosis, has become the first-line evidence-based management strategy during recent years. Hormonal treatment of heavy menstrual bleeding (HMB) is also endorsed as the first line of treatment in several international guidelines. In the present article, we review the efficacy of the commonly used and widely available hormonal treatments of AUB-O, AUB-E and AUB-C. The therapies include combined hormonal contraceptives, progestin-only preparations, and intrauterine release of levonorgestrel through the levonorgestrel-releasing intrauterine system. In addition, we make practical recommendations for patient management. We also review some of the current guidelines and their recommendations concerning the treatment of HMB. Finally, the effects of hormonal treatment on the overall management of AUB and its effects on the health care system and specialist training are discussed.
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Affiliation(s)
- Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, P.O. Box 610, 00029-HUS, Helsinki, Finland.
| | - Ian Fraser
- University of New South Wales, School of Women's and Children's Health, Royal Hospital for Women, Randwick, Sydney, NSW 2031, Australia
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Pakrashi T, Taylor JE, Nelson A, Archer DF, Jacot T. The Effect of Levonorgestrel on Fibrinolytic Factors in Human Endometrial Endothelial Cells. Reprod Sci 2016; 23:1536-1541. [DOI: 10.1177/1933719116645193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Tarita Pakrashi
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine/Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Ashley Nelson
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine/Eastern Virginia Medical School, Norfolk, VA, USA
| | - David F. Archer
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine/Eastern Virginia Medical School, Norfolk, VA, USA
| | - Terry Jacot
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine/Eastern Virginia Medical School, Norfolk, VA, USA
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26
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Javan R, Yousefi M, Nazari SM, Amiri P, Mosavi-Jarrahi A, Modiramani P, Naghedi-Baghdar H. Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review. Phytother Res 2016; 30:1584-1591. [DOI: 10.1002/ptr.5675] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/15/2016] [Accepted: 06/07/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Roghayeh Javan
- Student Research Committee, Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mahdi Yousefi
- Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Seyed-Mohammad Nazari
- Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Parastoo Amiri
- Iranian Research on Healthy Aging (IRCHA); Sabzevar University of Medical Sciences; Sabzevar Iran
| | - Alireza Mosavi-Jarrahi
- Department of Health and Community Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | | | - Hamideh Naghedi-Baghdar
- Student Research Committee, Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
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Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res 2016; 143:91-100. [PMID: 27208978 DOI: 10.1016/j.thromres.2016.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 11/20/2022]
Abstract
Unpredictable, prolonged or heavy menstrual bleeding (HMB) may be expected for many adolescents soon after menarche. A decade of clinical experience and research has now established firmly that bleeding disorders (BD) are common in adolescents with HMB. Despite these advances, many questions remain, and several aspects of the diagnosis and management of BDs in adolescents are not supported by rigorous clinical trials. In this overview, four major areas will be discussed. First, we will discuss the frequency of BDs in young women with HMB. Up to 20% of older females with HMB are thought to have an underlying BD. Estimates from retrospective studies in adolescents suggest a prevalence that varies anywhere from 10 to 62%. Prospective studies with uniform hemostatic evaluation are needed to answer this question definitively. Second, we will review existing tools that help screen and diagnose adolescents with HMB with an underlying BD. Although identification of an underlying BD in older women with HMB is relatively straight forward, uncertainties remain for adolescents. Heavy menstrual bleeding in this age group may have different pathophysiological underpinnings than those in older women and may often be disregarded as anovulatory. There is an urgent need to develop novel tools, and evaluate existing diagnostic strategies in adolescents. Third, we will discuss the optimal medical management of HMB in young adolescents. As direct evidence is largely lacking, these areas are also subject to extrapolation from older women. Lastly, an important area- prediction, and management of future bleeding in those adolescents who are diagnosed with a mild BD-will be discussed. Throughout, areas of controversy and opportunities for further research are highlighted.
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28
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Chen YJ, Li YT, Huang BS, Yen MS, Sheu BC, Chow SN, Wang PH. Medical treatment for heavy menstrual bleeding. Taiwan J Obstet Gynecol 2015; 54:483-8. [DOI: 10.1016/j.tjog.2015.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/12/2022] Open
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