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Chen CM, Tseng YH, Jui-Shan Lin S, Chen LL, Lin JD, Su YC. A quick method to customize pictorial blood assessment tools towards better measurement: Method development and validation. Taiwan J Obstet Gynecol 2024; 63:506-512. [PMID: 39004477 DOI: 10.1016/j.tjog.2022.08.023] [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] [Accepted: 08/12/2022] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVE Identification of heavy menstrual bleeding (HMB) cases in primary care settings is often done by using pictorial blood assessment charts (PBAC). The study aims to highlight the challenge of assessing blood loss, to develop a standardized method to efficiently customize a patient-reported pictorial chart, to validate the tool produced with our proposed method, and to demonstrate the feasibility of using PBACs in settings where resources are scarce. MATERIALS AND METHODS Using blood samples and feedback from 21 women aged 30-51 years, we followed guidelines suggested in the literature, developed a method to produce PBACs for regular, long and night sizes, and had 9 participants testuse them. Linear regression analysis was performed to determine the correlation between participants' scores and menstrual blood weight. RESULTS The study demonstrated the feasibility of customizing product-sensitive and size-specific pictorial charts by adopting essential steps including collecting menstrual blood with menstrual cups, employing fluid application techniques, and using sanitary pads as icons for easy identification. Linear regression analyses of score versus blood weight showed that the recorded blood weight was around 95% of the scored values (R2 = 0.9428, 0.947, and 0.9508, respectively; p < 0.001). CONCLUSION Valid patient-reported PBACs created by the proposed method provides an innovative women's healthcare solution to assist HMB identification and reduce health expenditure by preventing risks for HMB related complications in varying economic and technological contexts. Women's participation in tracking menstrual abnormalities may improve health literacy.
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Affiliation(s)
- Chien-Ming Chen
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Hwei Tseng
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Sunny Jui-Shan Lin
- Department of Chinese Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Li-Li Chen
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
| | - Jun-Dai Lin
- Department of Nursing & Department of Health Administration, Asia University, Taichung, Taiwan
| | - Yi-Chang Su
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan.
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Acharya N, Mishra P, Mohammad S, Karnik M, Muneeba S, Gemnani R, Saboo K, Shukla S, Acharya S. Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update. Cureus 2023; 15:e47877. [PMID: 38021492 PMCID: PMC10681274 DOI: 10.7759/cureus.47877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common cause of gynecological complaints in perimenopausal women. The treatment chosen by most of the women having HMB/AUB in the perimenopausal age group when medical therapy fails is hysterectomy, which unfortunately has significant issues related to safety and long-term quality of life apart from being a burden on the health care system and cost to patients. Minimal access surgical techniques like hysteroscopic targeted therapies are available which are conservative and spare the uterus and major surgery and its complications and sequelae. Hysteroscopic management of HMB is a minimally invasive and targeted approach in diagnosing and treating the pathological lesions causing the symptoms and not radical like hysterectomy which has more chances of occurrence of adverse events both intra and postoperatively. In terms of health-related quality of life, women suffering from HMB who underwent a hysteroscopic conservative approach had better scores when compared to those with hysterectomy. The present review aims to review the evidence generated to compare the two surgical modalities, hysteroscopic targeted therapy and hysterectomy, in terms of their effectiveness, safety, and effect on the quality of life of these perimenopausal women having HMB/AUB.
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Affiliation(s)
- Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Megha Karnik
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shaikh Muneeba
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Shea AA, Wever F, Ventola C, Thornburg J, Vitzthum VJ. More than blood: app-tracking reveals variability in heavy menstrual bleeding construct. BMC Womens Health 2023; 23:170. [PMID: 37041503 PMCID: PMC10088691 DOI: 10.1186/s12905-023-02312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is associated with impaired quality of life and may signal serious health problems. Unresolved challenges in measuring menstrual bleeding and identifying HMB have hampered research and clinical care. Self-reported bleeding histories are commonly used but these may be influenced by recall bias, personal beliefs regarding "normal" flow volume, and the experience of other physical symptoms or disruptions to daily life. The potential usefulness of menstrual-tracking mobile applications, which allow real-time user-entered data recording, for assessing HMB has not been studied. We evaluated recall bias in reported period duration, the relationship of tracked period duration and daily flow volume to subsequently reported period heaviness, variation in quality of life associated with increasing period heaviness, and the advantages and limitations of using app-tracked data for clinical and research purposes. METHODS An online questionnaire was distributed to current users of Clue, a commercially available menstrual health tracking app, asking them to characterize their last period. We compared responses to the user's corresponding Clue app-tracked data. The study sample comprised 6546 U.S.-based users (aged 18-45 years). RESULTS Increasing reported heaviness was associated with increasing app-tracked period length and days of heavy flow, impaired quality-of-life (especially body pain severity), and disrupted activities. Of those reporting having had a heavy/very heavy period, ~ 18% had not tracked any heavy flow, but their period length and quality-of-life indicators were similar to those who had tracked heavy flow. Sexual/romantic activities were the most affected across all flow volumes. Compared to app-tracked data, 44% recalled their exact period length; 83% recalled within ± 1 day. Overestimation was more common than underestimation. However, those with longer app-tracked periods were more likely to underestimate period length by ≥ 2 days, a pattern which could contribute to under-diagnosis of HMB. CONCLUSION Period heaviness is a complex construct that encapsulates flow volume and, for many, several other bleeding-associated experiences (period length, bodily impairments, disruptions of daily activities). Even very precise flow volume assessments cannot capture the multi-faceted nature of HMB as experienced by the individual. Real-time app-tracking facilitates quick daily recording of several aspects of bleeding-associated experiences. This more reliable and detailed characterization of bleeding patterns and experiences can potentially increase understanding of menstrual bleeding variability and, if needed, help to guide treatment.
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Affiliation(s)
- Amanda A Shea
- Clue by BioWink GmbH, Adalberstrasse 7-8, 10999, Berlin, Germany
| | | | - Cécile Ventola
- Clue by BioWink GmbH, Adalberstrasse 7-8, 10999, Berlin, Germany
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Perelló-Capo J, Rius-Tarruella J, Andeyro-García M, Calaf-Alsina J. Sensitivity to Change of the SAMANTA Questionnaire, a Heavy Menstrual Bleeding Diagnostic Tool, After 1 Year of Hormonal Treatment. J Womens Health (Larchmt) 2023; 32:208-215. [PMID: 36576860 DOI: 10.1089/jwh.2022.0155] [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] [Indexed: 12/29/2022] Open
Abstract
Background: The validated SAMANTA questionnaire allows identification of women with heavy menstrual bleeding (HMB); that is, with excessive menstrual bleeding that interferes with quality of life (QoL). We assessed its value for monitoring HMB treatment in clinical practice. Material and Methods: This is a prospective observational study conducted between December 2018 and March 2021 in consecutively recruited women with HMB attending gynecologists' offices who started a hormonal treatment. Sociodemographic characteristics were recorded at enrollment. At baseline and month 12, we assessed the HMB (SAMANTA questionnaire), the global impression of menstrual bleeding severity in patients (PGI-S) and clinicians (CGI-S), and the QoL (SF36). At month 12, we assessed the global impression of menstrual bleeding change in patients (PGI-C) and clinicians (CGI-C). Changes in SAMANTA questionnaire score at month 12 were compared with the presence of amenorrhea and changes in blood loss, menstrual period duration, and PGI-S, PGI-C, CGI-S, and CGI-C. Results: The study included 371 women aged 41.2 ± 6.5 years, 87% of whom were using the levonorgestrel intrauterine system. The SAMANTA questionnaire score significantly decreased in 97.3% of women. The decrease was greater in women reporting a reduction in blood loss, shorter menstrual bleeding duration, or a strong improvement in menstrual bleeding severity (PGI-S and CGI-S) or amount (PGI-C and CGI-C) (p < 0.001 for all), but not amenorrhea. SF-36 domains improved significantly; changes being inversely associated with changes in the SAMANTA questionnaire score. Conclusions: The SAMANTA questionnaire seems a valuable tool for monitoring hormonal treatment for HMB. ClinicalTrials.gov identifier NCT03751800.
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Affiliation(s)
- Josep Perelló-Capo
- Department of Obstetrics and Gynecology, Hospital de Sant Pau, Barcelona, Spain
- Paediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Joaquim Calaf-Alsina
- Department of Obstetrics and Gynecology, Hospital de Sant Pau, Barcelona, Spain
- Paediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Perelló J, Pujol P, Pérez M, Artés M, Calaf J. Heavy Menstrual Bleeding-Visual Analog Scale, an Easy-to-Use Tool for Excessive Menstrual Blood Loss That Interferes with Quality-of-Life Screening in Clinical Practice. WOMEN'S HEALTH REPORTS 2022; 3:483-490. [PMID: 35651998 PMCID: PMC9148653 DOI: 10.1089/whr.2021.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/12/2022]
Abstract
Background: Materials and Methods: Results: Conclusion:
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Affiliation(s)
- Josep Perelló
- Department of Obstetrics and Gynecology, Hospital de Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Joaquim Calaf
- Department of Obstetrics and Gynecology, Hospital de Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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6
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Alsalman M, Albarak A, Busaleh F, Alshaikh S, Alluwaim M, Busaleh M, Albarrak A. Heavy menstrual bleeding awareness among Saudi female population and clinical implications. Health Sci Rep 2021; 4:e244. [PMID: 33614981 PMCID: PMC7877709 DOI: 10.1002/hsr2.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is a common clinical problem. However, seeking medical advice might be delayed until patients develop several clinical consequences. AIM To assess the prevalence and awareness of HMB among the Saudi female population and measures that are commonly used to control the bleeding. METHOD This is a cross-sectional study where a trained study team member carried out a survey. The survey includes patient demographics and medications history, comorbidities, blood transfusion, and patient perception about her period. HMB was defined as bleeding lasting >7 days, flooding or changing protection more than every 2 hours, and passing clots >1 in. in diameter. RESULTS Four hundred and thirty-one women were evaluated for HMB with a median age of 27.72 ± 7.75. Out of the total number, 281 (65.2%) females were identified to have HMB. Among these 281 females, only 35.6% were aware of having HMB, whereas 64.4% either unaware or unsure about having it. For those who were aware of having HMB, only 32% seek medical advice, particularly gynecology clinic though 46.6% were not satisfied with offered management. On the other hand, 28% and 3.9% of those unaware of having HMB did required iron supplementation and blood transfusion, respectively. CONCLUSION HMB is a major clinical problem though awareness about having HMB lacks regardless of the age and education level. Raising awareness and a multidisciplinary approach may result in early diagnosis, early intervention, and reduction of clinical consequences.
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Affiliation(s)
- Mortadah Alsalman
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Ashjan Albarak
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Fatemah Busaleh
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Salwa Alshaikh
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Mariam Alluwaim
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Mariya Busaleh
- Department of Medicine, College of MedicineKing Faisal UniversityAl‐AhsaSaudi Arabia
| | - Ayman Albarrak
- Department of PediatricMaternity and Children HospitalAl‐AhsaSaudi Arabia
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7
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Magnay JL, O'Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC WOMENS HEALTH 2020; 20:24. [PMID: 32041594 PMCID: PMC7011238 DOI: 10.1186/s12905-020-0887-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022]
Abstract
Background Pictorial blood loss assessment charts (PBACs) represent the most widely used method to assess menstrual blood loss (MBL) in clinical trials. The aims of this review were to: (1) determine the diagnostic accuracy of PBACs that have been validated against the reference alkaline hematin technique; (2) categorize the pitfalls of using obsolete and nonvalidated charts; (3) provide guidelines for development of a new PBAC or use of an existing chart to measure MBL in clinical trials; and (4) consider the feasibility of using pictorial charts in primary care. Methods A literature review was conducted using Embase and MEDLINE databases. The review identified reports of women with self-perceived or actual heavy menstrual bleeding (HMB), bleeding disorders, abnormal uterine bleeding, leiomyomata (uterine fibroids) or endometriosis, and women undergoing treatment for HMB, as well as those with normal menstrual periods. Data were reviewed from studies that focused on the development and validation of PBACs and from those that used derivative noncertified charts to assess HMB. Results Nine studies reported validation of PBAC scoring systems against the alkaline hematin technique. Across these studies, the sensitivity was 58–97%, the specificity was 7.5–95.5%, the positive and negative likelihood ratios were 1.1–13.8 and 0.14–0.56, respectively, and the diagnostic odds ratio was 2.6–52.4. The cut-off score above which the diagnosis of HMB was made ranged from 50 to 185. Several modifications of these PBACs were used in other studies; however, objective confirmation of their validity was not reported. Overall, there was widespread inconsistency of chart design, scoring systems, diagnostic cut-off limits and post-treatment outcome measures. Conclusions PBACs are best suited to the controlled and specific environment of clinical studies, where clinical outcome parameters are defined. The current lack of standardization precludes widespread use of the PBAC in primary care. Review registration number PROSPERO international prospective register of systematic reviews: CRD42016030083.
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Affiliation(s)
- Julia L Magnay
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK.,Department of Obstetrics & Gynaecology, Keele University School of Medicine, Stoke-on-Trent, UK
| | - Christoph Gerlinger
- Bayer AG, Building P300, 13342, Berlin, Germany.,Gynaecology, Obstetrics and Reproductive Medicine, University of Saarland Medical School, Homburg, Saar, Germany
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Matsubara S, Kawaguchi R, Akinishi M, Nagayasu M, Iwai K, Niiro E, Yamada Y, Tanase Y, Kobayashi H. Subtype I (intrinsic) adenomyosis is an independent risk factor for dienogest-related serious unpredictable bleeding in patients with symptomatic adenomyosis. Sci Rep 2019; 9:17654. [PMID: 31776404 PMCID: PMC6881344 DOI: 10.1038/s41598-019-54096-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022] Open
Abstract
We aimed to retrospectively analyze the risk factors of a continuous dienogest (DNG) therapy for serious unpredictable bleeding in patients with symptomatic adenomyosis. This is a retrospective study based on data extracted from medical records of 84 women treated with 2 mg of DNG orally each day between 2008 and 2017. 47 subjects were excluded from the original analyses due to an inadequate subcategorization into subtype I and subtype II and a lack of hemoglobin levels. The influence of various independent variables on serious unpredictable bleeding was assessed. Of the 37 eligible patients who received the continuous DNG therapy, 14 patients experienced serious unpredictable bleeding. Univariate analysis revealed that the serious bleeding group had subtype I adenomyosis (P = 0.027). There was no correlation between age, parity, minimum hemoglobin level before treatment, previous endometrial curettage, and duration of DNG administration, or uterine or adenomyosis size and the serious bleeding. A DNG-related serious unpredictable bleeding is associated with the structural type of adenomyosis (subtype I) in patients with symptomatic adenomyosis.
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Affiliation(s)
- Sho Matsubara
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan.
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Mika Akinishi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Mika Nagayasu
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Kana Iwai
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Emiko Niiro
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Yuki Yamada
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Yasuhito Tanase
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
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O'Brien SH, Saini S, Ziegler H, Christian-Rancy M, Ahuja S, Hege K, Savelli SL, Vesely SK. An Open-Label, Single-Arm, Efficacy Study of Tranexamic Acid in Adolescents with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2019; 32:305-311. [PMID: 30731217 DOI: 10.1016/j.jpag.2019.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Heavy menstrual bleeding (HMB) occurs in up to 40% of adolescent girls, significantly affecting their daily activities. Identifying alternative treatment strategies for HMB is particularly important for adolescents who prefer not to take hormonal contraception. Our objective was to determine whether use of tranexamic acid (TA) would increase health-related quality of life and decrease menstrual blood loss (MBL) in adolescents with HMB. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: In an open-label, multi-institutional, single-arm, efficacy study, patients 18 years of age or younger with HMB were treated with oral TA 1300 mg 3 times daily during the first 5 days of menses and monitored over the course of 4 menstrual cycles (1 baseline; 3 treatment cycles). Assessment of MBL was performed using the Menorrhagia Impact Questionnaire (MIQ) and the Pictorial Blood Assessment Chart. The MIQ includes Likert scale items, validated to assess the influence of HMB on quality of life. In previous studies, a 1-point decrease or more in score correlated with clinically significant improvement. RESULTS Thirty-two patients enrolled in the study, and 25 had sufficient follow-up data to be deemed evaluable. The mean age of the participants was 14.7 years (range, 11-18 years). There was an overall improvement in all items of the MIQ, with a greater than 1-point improvement in the MIQ perceived blood loss scale. When using TA, mean Pictorial Blood Assessment Chart score improved by 100 points. There were no medication-related serious adverse events. CONCLUSION Use of TA in female adolescents with HMB is well tolerated and leads to clinically meaningful reduction in MBL.
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Affiliation(s)
- Sarah H O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio; Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Surbhi Saini
- Division of Pediatric Hematology/Oncology, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Heidi Ziegler
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio
| | - Myra Christian-Rancy
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio
| | - Sanjay Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospitals, Cleveland, Ohio
| | - Kerry Hege
- Division of Pediatric Hematology/Oncology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Stephanie L Savelli
- Division of Pediatric Hematology/Oncology, Akron Children's Hospital, Akron, Ohio
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Halimeh S, Rott H, Kappert G. PBAC score: an easy-to-use tool to predict coagulation disorders in women with idiopathic heavy menstrual bleeding. Haemophilia 2016; 22:e217-20. [PMID: 27028334 DOI: 10.1111/hae.12886] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Affiliation(s)
- S Halimeh
- Coagulation Centre Rhine-Ruhr, Medical Thrombosis and Haemophilia Treatment Centre and Specialized Laboratory for Coagulation Disorders/Haemophilia, Duisburg, Germany
| | - H Rott
- Coagulation Centre Rhine-Ruhr, Medical Thrombosis and Haemophilia Treatment Centre and Specialized Laboratory for Coagulation Disorders/Haemophilia, Duisburg, Germany
| | - G Kappert
- Coagulation Centre Rhine-Ruhr, Medical Thrombosis and Haemophilia Treatment Centre and Specialized Laboratory for Coagulation Disorders/Haemophilia, Duisburg, Germany
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11
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Hormonal contraception as treatment for heavy menstrual bleeding: a systematic review. Clin Obstet Gynecol 2015; 57:694-717. [PMID: 25314086 DOI: 10.1097/grf.0000000000000061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A systematic review to compare the effectiveness of contraceptives to treat heavy menstrual bleeding (HMB). PubMed was searched for studies using hormonal contraceptive methods to treat HMB. Two reviewers screened 734 citations and extracted eligible trials based on rigid inclusion and exclusion criteria. Fourteen articles met inclusion criteria. The evidence was good to poor quality and suggested that all contraceptives tested were effective in the treatment of HMB, but the levonorgestrel intrauterine system was the most effective method. Hormonal contraceptives effectively treat HMB. The levonorgestel intrauterine system is the superior method.
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12
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Finco A, Centini G, Lazzeri L, Zupi E. Surgical Management of Abnormal Uterine Bleeding in Fertile Age Women. WOMENS HEALTH 2015; 11:513-25. [DOI: 10.2217/whe.15.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman.
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Affiliation(s)
- Andrea Finco
- Department of Biomedicine & Prevention, Obstetrics & Gynecological Clinic, University of Rome “Tor Vergata”, Viale Oxford, 81, 00133, Rome, Italy
| | - Gabriele Centini
- Department of Molecular & Developmental Medicine, University of Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular & Developmental Medicine, University of Siena, Italy
| | - Errico Zupi
- Department of Molecular & Developmental Medicine, University of Siena, Italy
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13
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Hysteroscopic Endometrial Resection Versus Laparoscopic Supracervical Hysterectomy for Abnormal Uterine Bleeding: Long-term Follow-up of a Randomized Trial. J Minim Invasive Gynecol 2015; 22:841-5. [PMID: 25881883 DOI: 10.1016/j.jmig.2015.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare long-term efficacy of laparoscopic supracervical hysterectomy (LSH) and hysteroscopic endometrial ablation (HEA) in treating persistent abnormal uterine bleeding. DESIGN Canadian Task Force II-2. SETTING University hospital. PATIENTS One hundred fifty-three women treated for abnormal uterine bleeding by LSH or HEA. INTERVENTION Long-term follow-up assessment of reintervention rate and quality of life (QoL) using the Quality Metric's Health Survey Short Form 12. MEASUREMENT AND MAIN RESULTS This study is the long-term follow-up of a randomized control trial conducted in 2003 comparing LSH and HEA in terms of reoperation rate and QoL. Starting from November 2010 all patients included in the first trial were invited to participate in this study and clinically evaluated through vaginal examination and transvaginal ultrasound. After a mean follow-up of 14.4 years, 29% of patients (20/71) treated with HEA underwent further surgery, whereas no patients after LSH had symptom recurrence. The reintervention rate was significantly higher in the HEA group (p < .0001), with a relative risk of 1.39 (95% confidence interval, 1.20-1.61). The assessment of QoL demonstrated a higher score, in both physical and mental components, in the LSH group (p < .0001). CONCLUSION The lower reintervention rate and the better physical and mental health scores make LSH a more suitable procedure to treat recurrent abnormal uterine bleeding when compared with HEA.
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Abstract
The prevalence of symptomatic childhood venous thromboembolism increases among adolescents. The occurrence of nonhereditary prothrombotic risk factors, e.g. oral contraceptive pills, often prescribed to adolescent females for various indications, such as tobacco use, obesity and hypertension may trigger symptomatic thrombosis, especially in carriers of genetic thrombophilia traits. On the other hand, heavy menstrual bleeding is a common clinical problem of young adolescent women. A proper diagnostic workup of these women may enable physicians to detect and treat congenital bleeding disorders, e.g. von Willebrand disease, presenting with menorrhagia. The challenges of diagnosis and treatment of either thrombosis or bleeding disorders in young adults will be discussed in this review.
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Affiliation(s)
- Ulrike Nowak-Göttl
- Department of Coagulation and Haemostasis, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein at Campus Kiel, Kiel, Germany
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