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Özcan H, Burger NB, Dulmen-den Broeder EV, van Baal MW, den Boogaard EV, De Leeuw RA, Huirne JAF. Instruments to Identify Menstrual Complaints and Their Impact on Adolescents: A Systematic Review. J Pediatr Adolesc Gynecol 2024; 37:106-120. [PMID: 38104798 DOI: 10.1016/j.jpag.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
STUDY OBJECTIVE The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents. METHODS The search was conducted in PubMed, Web of Science, Embase, and PsycINFO on December 1, 2022. Studies published in English reporting on menstrual complaints among girls aged 10-19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which 8 were validated in adolescents. One was difficult to use in daily practice, 1 had low sensitivity and specificity in the detection of HMB, 2 were validated by face validity, and 2 were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only 2 were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood Loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cutoff value for HMB and low sensitivity and specificity. CONCLUSION We found that the PIPPA and aMBQ are suitable for assessing menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC, which is used frequently in adults, needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cutoff value for HMB should be determined for this age group. Considering the different interpretations, experiences, and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Marchien W van Baal
- Department of Obstetrics and Gynaecology, Flevo Hospital, Almere, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands.
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MokhtarKalimi E, Loripoor M, Rezaeian M, Gholamrezapour M. The effect of iron supplementation on menstrual bleeding volume and hemoglobin level during menstrual bleeding : A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:19. [PMID: 38532920 PMCID: PMC10965019 DOI: 10.4103/jehp.jehp_1871_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Many women around the world avoid taking iron supplements during their menstrual bleeding, thinking that menstrual bleeding will increase after taking these supplements. Due to the lack of relevant scientific evidence in this regard, this study was performed to determine the effect of iron supplementation on menstrual blood volume and hemoglobin level during menstrual bleeding. MATERIALS AND METHODS In this three-blind randomized clinical trial, 160 non-anemic female students of Rafsanjan University of Medical Sciences were selected through a public call and then they were randomly assigned to two intervention and control groups. The intervention group was given a ferrous sulfate tablet containsing 50 mg of elemental iron daily in the first four days of bleeding for three consecutive menstrual cycles, and the control group received a placebo simultaneously. Before and after the intervention, the level of hemoglobin was measured and the Higham chart was completed in each menstrual cycle by the participants of the two groups. The obtained data were analyzed using the SPSS software version 21 and Chi-square, independent t-test, paired t-test, analysis of variance with repeated measures, and nonparametric tests. RESULTS Before performing the intervention, the mean Higham score and hemoglobin level of the two groups were not statistically significant (P = 0.307, P = 0.670). The mean Higham score after each intervention was not statistically significant between the two groups over time or when considering the interaction of the time group (P = 0.77, P = 0.916). The hemoglobin level of these two groups did not change significantly after the intervention compared with that before the intervention (P = 0.444). CONCLUSION Compared with a placebo, taking iron supplements containing 50 mg of elemental iron during the first four days of menstrual bleeding in non-anemic women did not change the volume of menstrual bleeding and hemoglobin level.
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Affiliation(s)
- Elnaz MokhtarKalimi
- Department of Midwifery, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, School of Medicine, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - MohammadReza Gholamrezapour
- Department of Internal Medicine, School of Medicine, Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Medina-Perucha L, López-Jiménez T, Pujolar-Díaz G, Martínez-Bueno C, Munrós-Feliu J, Valls-Llobet C, Jacques-Aviñó C, Holst AS, Pinzón-Sanabria D, Vicente-Hernández MM, García-Egea A, Berenguera A. Menstrual characteristics and associations with sociodemographic factors and self-rated health in Spain: a cross-sectional study. BMC Womens Health 2024; 24:88. [PMID: 38310222 PMCID: PMC10838449 DOI: 10.1186/s12905-023-02840-z] [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: 09/28/2022] [Accepted: 12/12/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Evidence on how menstrual characteristics may differ based on socioeconomic factors and self-rated health is significantly scarce. The main aim of this study was to investigate the associations between menstrual characteristics, sociodemographic factors and self-rated health among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS This cross-sectional study includes data from an online survey collected in March-July 2021 across Spain. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS The analyses included a total of 19,358 women and PWM. Mean age at menarche was 12.4 (SD = 1.5). While 20.3% of our participants experienced a menstrual abundance over 80 ml, 64.1% reported having menstrual blood clots; 6.4% menstruated for longer than 7 days. 17.0% had menstrual cycles that were shorter than 21 days or longer than 35 days. Reports of moderate (46.3%) and high (22.7%) intensity menstrual pain were common. 68.2% of our participants experienced premenstrual symptoms in all or most cycles. The odds for lighter menstrual flow, shorter bleeding days and menstrual cycles were higher as age increased, and amongst participants with less educational attainment. Caregivers presented higher odds for abundant menstrual flow and longer menstruations. Reporting financial constraints and a poorer self-rated health were risk factors for abundant menstrual flow, menstrual blood clots, shorter/longer menstruations and menstrual cycles, premenstrual symptoms, moderate and intense menstrual pain. CONCLUSIONS This study suggests that age, educational attainment, caregiving, experiencing financial hardship and a poorer self-rated health may shape or mediate menstrual characteristics. It thus highlights the need to investigate and address social inequities of health in menstrual research.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain.
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Georgina Pujolar-Díaz
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Cristina Martínez-Bueno
- Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR). Direcció Assistencial d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Jordina Munrós-Feliu
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de la Salut, Barcelona, Spain
| | | | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | | | - Andrea García-Egea
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autonoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Bhat RV, Young G, Sharathkumar AA. How I treat pediatric venous thromboembolism in the DOAC era. Blood 2024; 143:389-403. [PMID: 37390311 PMCID: PMC10862368 DOI: 10.1182/blood.2022018966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023] Open
Abstract
ABSTRACT The direct oral anticoagulants (DOACs) rivaroxaban and dabigatran are newly licensed for the treatment and prevention of venous thromboembolism (VTE) in children and mark a renaissance in pediatric anticoagulation management. They provide a convenient option over standard-of-care anticoagulants (heparins, fondaparinux, and vitamin K antagonists) because of their oral route of administration, child-friendly formulations, and significant reduction in monitoring. However, limitations related to therapeutic monitoring when needed and the lack of approved reversal agents for DOACs in children raise some safety concerns. There is accumulating experience of safety and efficacy of DOACs in adults for a broad scope of indications; however, the cumulative experience of using DOACs in pediatrics, specifically for those with coexisting chronic illnesses, is sparse. Consequently, clinicians must often rely on their experience for treating VTE and extrapolate from data in adults while using DOACs in children. In this article, the authors share their experience of managing 4 scenarios that hematologists are likely to encounter in their day-to-day practice. Topics addressed include (1) appropriateness of indication; (2) use for special populations of children; (3) considerations for laboratory monitoring; (4) transition between anticoagulants; (5) major drug interactions; (6) perioperative management; and (7) anticoagulation reversal.
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Affiliation(s)
- Rukhmi V. Bhat
- Center for Cancer and Blood Disorders, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Guy Young
- Cancer and Blood Disorders Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anjali A. Sharathkumar
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA
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Kempers EK, van der Zande JA, Janssen PM, Cornette JM, Roos-Hesselink JW, Kruip MJ. Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review. Res Pract Thromb Haemost 2024; 8:102295. [PMID: 38268520 PMCID: PMC10805676 DOI: 10.1016/j.rpth.2023.102295] [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: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background The effects of antiplatelet therapy on menstrual bleeding have not been well characterized. Objectives To systematically review the effects of antiplatelet therapy on menstrual bleeding. Methods A literature search was performed for studies of reproductive-aged women who received antiplatelet therapy. Characteristics of menstrual bleeding both before and after initiation of antiplatelet therapy and from comparison groups were collected. Two reviewers independently assessed the risk of bias in individual studies. Results Thirteen studies with a total of 611 women who received antiplatelet therapy were included. Types of antiplatelet drugs used were aspirin (n = 8), aspirin and/or clopidogrel (n = 2), prasugrel (n = 1), and not specified (n = 2). Risk of bias was assessed at moderate (n = 1), serious (n = 8), critical (n = 2), and no information (n = 2). Three studies reported changes in menstrual blood loss volume. One of these showed no increase during antiplatelet therapy; the other 2 studies suggested that aspirin may increase menstrual blood loss volume. In 3 studies that assessed the duration of menstrual bleeding, up to 13% of women reported an increased duration of menstruation. In 5 studies that reported the intensity of menstrual flow, 13% to 38% of women experienced an increase in the intensity of flow. Five studies reported the prevalence of heavy menstrual bleeding in women who received antiplatelet therapy, with estimates ranging from 7% to 38%. Conclusion There is lack of high-quality data on the effects of antiplatelet therapy on menstrual bleeding. Aspirin may increase menstrual blood loss, at least in a minority of women, whereas the effects of P2Y12 inhibitors are unknown.
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Affiliation(s)
- Eva K. Kempers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanna A. van der Zande
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paula M. Janssen
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jérôme M.J. Cornette
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Marieke J.H.A. Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Martens KL, Samuelson Bannow B. Antiplatelet period drama: a rush of blood or classic crimson tide? Res Pract Thromb Haemost 2024; 8:102320. [PMID: 38356853 PMCID: PMC10865471 DOI: 10.1016/j.rpth.2024.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Kylee L. Martens
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- The Hemostasis and Thrombosis Center at Oregon Health & Science University, Portland, Oregon, USA
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7
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Liang J, Ali F, Ramaiyer M, Borahay MA. Determinants and Assessment of Menstrual Blood Flow. CURR EPIDEMIOL REP 2023; 10:210-220. [PMID: 38275001 PMCID: PMC10810143 DOI: 10.1007/s40471-023-00332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review a)The modifiable and non-modifiable determinants and the currently available methods of assessment of menstrual blood flow will be discussed, with the goal of helping healthcare providers, researchers, and those interested in public health. Recent findings b)Several factors can impact menstruation. The determinants include modifiable factors such as smoking, nutrition, exercise, stress, weight fluctuation, and benign gynecologic diseases, and non-modifiable factors such as age, race, and the individual's genes. The intertwined dynamic among these determinants needs more critical attention. Currently, the methods for the assessment of menstruation all have advantages and disadvantages, often with a tradeoff between practicality and accuracy. Summary c)Considered by many as the fifth vital, menstruation provides a window to an individual's general health. The discussion of its determinants and assessment can be more appropriate for individual contexts, especially from a public health perspective as it can improve the reproductive health of the population.
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Affiliation(s)
- Jinxiao Liang
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Malini Ramaiyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
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Klusmann H, Eisenlohr-Moul T, Baresich K, Schmalenberger KM, Girdler S, Andersen E. Analyzing the atypical - Methods for studying the menstrual cycle in adolescents. Psychoneuroendocrinology 2023; 158:106389. [PMID: 37769538 PMCID: PMC10843271 DOI: 10.1016/j.psyneuen.2023.106389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/08/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The female pubertal transition is characterized by a rapidly changing hormone milieu, which is heavily influenced by the first menstrual cycle - menarche. The first year following menarche is associated with menstrual cycles that are irregular and anovulatory. Peripuberty also marks the beginning of a female-biased risk for suicidality and depression, suggesting some influence by the menstrual cycle and ovarian hormone fluctuations. However, there are limited methods and guidelines for studying the menstrual cycle and related affective symptoms in this developmental window. Thus, this study's objective was to identify the most accurate methods for detecting ovulation in irregular cycles (Part 1) and develop guidelines based on these methods for determining menstrual cycle phases. These methods were applied to investigate hormones and affective symptoms based on cycle phase and ovulation status in a sample of peripubertal females (Part 2). METHODS Thirty-two peripubertal females (ages 11-14) provided daily urine samples of estrogen (E1G) and progesterone (PdG) metabolites and luteinizing hormone (LH), and ratings of affective symptoms for one menstrual cycle. Ten literature-derived methods for determining the presence of an LH-peak or PdG rise were compared, focusing on their feasibility for psychological research. RESULTS Methods by Sun et al. (2019) and Park et al. (2007) most accurately detected PdG rises and LH peaks in this sample, identifying 40.6% of cycles as ovulatory. As expected, ovulatory participants showed greater LH in the periovulatory phase (p = .001), greater PdG in the mid-luteal phase (p < .0001), and greater E1G in the periovulatory phase (p = .001) compared with anovulatory participants. Exemplary methods to compare psychological symptoms between both groups are provided. CONCLUSIONS Recommendations and guidelines for studying the menstrual cycle in irregular cycling adolescents are offered. Novel methods for ovulation detection identified phase-specific hormonal patterns in anovulatory and ovulatory adolescent cycles.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Department of Psychiatry (MC 913), 60612 Chicago, USA.
| | - Kayla Baresich
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Katja M Schmalenberger
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Department of Psychiatry (MC 913), 60612 Chicago, USA.
| | - Susan Girdler
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Elizabeth Andersen
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
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Sinharoy SS, Chery L, Patrick M, Conrad A, Ramaswamy A, Stephen A, Chipungu J, Reddy YM, Doma R, Pasricha SR, Ahmed T, Chiwala CB, Chakraborti N, Caruso BA. Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study. Lancet Glob Health 2023; 11:e1775-e1784. [PMID: 37802092 PMCID: PMC10581908 DOI: 10.1016/s2214-109x(23)00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes. METHODS Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes. FINDINGS 4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β -3·34, 95% CI -7·04 to 0·37). INTERPRETATION Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem. FUNDING Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.
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Affiliation(s)
- Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Lyzberthe Chery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madeleine Patrick
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amelia Conrad
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Rinchen Doma
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - Tanvir Ahmed
- Department of Civil Engineering and International Training Network, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | | | | | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rezende GP, Brito LGO, Gomes DAY, de Souza LM, Polo S, Benetti-Pinto CL. Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women. SAO PAULO MED J 2023; 142:e2022539. [PMID: 37436255 PMCID: PMC10328441 DOI: 10.1590/1516-3180.2022.0539.r2.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.
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Affiliation(s)
- Gabriela Pravatta Rezende
- MD, MSc. Attending Physician, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Luiz Gustavo Oliveira Brito
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Daniela Angerame Yela Gomes
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Leticia Mansano de Souza
- Medical Student, School of Medical Sciences, Universidade
Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Sergio Polo
- Medical Student, School of Medical Sciences, Universidade
Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Cristina Laguna Benetti-Pinto
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
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11
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Radke EG, Christensen K. Invited Perspective: Challenges in Evaluating the Effect of Per- and Polyfluoroalkyl Substance Mixtures on Polycystic Ovarian Syndrome. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:51301. [PMID: 37134252 PMCID: PMC10156132 DOI: 10.1289/ehp12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Elizabeth G Radke
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Krista Christensen
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
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12
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Lee EJ, Ahn JE, Ryu JM, Jeong YY, Choi YS. Association between Patients' Self-Judgement, Coagulated Menstrual Blood, and Menorrhagia: Results from a Questionnaire Survey and Blood Test Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050874. [PMID: 37241106 DOI: 10.3390/medicina59050874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Menorrhagia is defined as a blood loss of more than 80 mL, which is significant enough to cause anemia. Previously known methods for evaluating menorrhagia, such as the alkalin-hematin method, pictograms, and measuring the weight of sanitary products, were all impractical, complex, and time-consuming. Therefore, this study aimed to determine which item among menstrual history taking was most associated with menorrhagia and devised a simple evaluating method for menorrhagia through history taking that can be applied clinically. Materials and Methods: The study was conducted from June 2019 to December 2021. A survey was conducted on premenopausal women who underwent outpatient treatment or surgery and those who underwent a gynecologic screening test, and their blood tests were analyzed. The presence of iron deficiency anemia was identified with a Hb level of less than 10 g/dL with microcytic hypochromic anemia on a complete blood count performed within one month of the survey. A questionnaire survey was conducted on six items related to menorrhagia to investigate whether each item was related to "significant menorrhagia". Results: There were 301 participants in the survey during the period. In univariate analysis, the results revealed a statistically significant association between significant menorrhagia and the following items: self-judgement of menorrhagia; menstruation lasting over 7 days; total pad counts in a single menstrual period; Number of sanitary products changed per day; and leakaging of menstrual blood and presence of coagulated menstrual blood. In multivariate analysis, only the "self-judgement of menorrhagia" item showed a statistically significant result (p-value = 0.035; an odds ratio = 2.217). When the "self-judgement of menorrhagia" item was excluded, the "passage of clots larger than one inch in diameter" item showed a statistically significant result (p-value = 0.023; an odds ratio = 2.113). Conclusions: "Patient self-judgement of menorrhagia" is a reliable item for evaluating menorrhagia. Among several symptoms indicating menorrhagia, determining the presence of the "passage of clots larger than one inch in diameter" during the menstrual period is the most useful item for evaluating menorrhagia in clinical history taking. This study suggested using these simple menstrual history taking items to evaluate menorrhagia in real clinical practice.
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Affiliation(s)
- Eun Ji Lee
- Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Ji Eun Ahn
- Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Jung Min Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Yoon Young Jeong
- Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Youn Seok Choi
- Department of Obstetrics and Gynecology, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
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13
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Lancastle D, Kopp Kallner H, Hale G, Wood B, Ashcroft L, Driscoll H. Development of a brief menstrual quality of life measure for women with heavy menstrual bleeding. BMC Womens Health 2023; 23:105. [PMID: 36918914 PMCID: PMC10011796 DOI: 10.1186/s12905-023-02235-0] [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: 10/05/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence advises that considerations around quality of life should be made when assessing and treating heavy menstrual bleeding. A quick and reliable method for women to assess the impact of HMB on their quality of life might encourage help-seeking. This research aimed to develop a new 10-item measure of menstrual quality of life (the PERIOD-QOL). METHODS Three pilot studies describe PERIOD-QOL development and a cross-sectional survey (N = 376) assessed PERIOD-QOL scores in women who reported HMB and those who did not. A population sample of women (mean age 30.29, SD = 9.06) completed the PERIOD-QOL and rated their menstrual bleeding as heavy/very heavy/extremely heavy (HMB group) or very light/light/moderate bleeding (LMMB) group. Data were analysed using independent samples Analysis of Variance and independent samples t-tests. RESULTS Cronbach's Alpha for the PERIOD-QOL = .88. A significant reduction in PERIOD-QOL scores was found across the 6 levels of bleeding from very light to extremely heavy, and significantly lower PERIOD-QOL scores were reported in the HMB than the LMMB group. CONCLUSION The results suggest that the PERIOD-QOL is a reliable measure and that women experiencing HMB reported significantly lower menstrual quality of life than those who did not. Further validation of the PERIOD-QOL is required to determine its relationships with existing measures of menstrual quality of life and to establish whether PERIOD-QOL scores are associated with decisions to seek help from health professionals and with verified diagnoses of conditions that cause HMB.
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Affiliation(s)
- Deborah Lancastle
- University of South Wales, Treforest Campus, Pontypridd, CF31 9DL, Wales, UK.
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Daneryd Hospital, Karolinska Insitutet, Stockholm, Sweden
| | - Gabrielle Hale
- University of South Wales, Treforest Campus, Pontypridd, CF31 9DL, Wales, UK
| | - Bethan Wood
- University of South Wales, Treforest Campus, Pontypridd, CF31 9DL, Wales, UK
| | - Lauren Ashcroft
- University of South Wales, Treforest Campus, Pontypridd, CF31 9DL, Wales, UK
| | - Holly Driscoll
- University of South Wales, Treforest Campus, Pontypridd, CF31 9DL, Wales, UK
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14
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Kalra S, Vaidya R, Verma M, Joshi A. Primary Care Screening Tool for Polycystic Ovary Syndrome: Step One in the Battle Against Non-Communicable Disease. Indian J Endocrinol Metab 2023; 27:105-106. [PMID: 37292072 PMCID: PMC10245304 DOI: 10.4103/ijem.ijem_333_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/06/2022] [Accepted: 01/06/2023] [Indexed: 06/10/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is often the first manifestation, in adolescents and young adults, of metabolic problems that may occur later. Early identification, timely referral and appropriate treatment can result in improved reproductive, metabolic and comprehensive health. However, unlike other components of metabolic syndrome, which can be diagnosed at primary care level, there is no inexpensive, clinical tool to screen for PCOS. We share a simple six-item questionnaire, structured in three domains, which can be used as a screening tool for the syndrome. This allows early diagnosis and management of the condition, facilitates a life course approach to health promotion, and lays the foundation for the prevention of other comorbid metabolic disorders. It also helps integrate national programmes concerning non-communicable disease and women's healthcare under one umbrella, thus optimizing and strengthening delivery of community care.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
| | - Rama Vaidya
- Hon. Director of the Division of Endocrine and Metabolic Disorders, Kasturba Health Society-Medical Research Center, Vile Parle (W), Mumbai, Maharashtra, India
| | - Madhur Verma
- University Center for Research and Development, Chandigarh University, Mohali, India
- Department of Community Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Ameya Joshi
- Department of Endocrinology, Bhaktivedanta Hospital And Research Institute, Mumbai, Maharashtra, India
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15
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Baldwin MK, Ahmadzia HK, Bartlett DL, Bensen-Kennedy D, Desai V, Haley KM, Herman-Hilker SL, Kilgore AM, Kulkarni R, Lavin M, Luckey S, Matteson KA, Paulyson-Nuñez K, Philipp CS, Ragosta S, Rosen K, Rotellini D, Weyand AC. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research to advance the health of people with inherited bleeding disorders with the potential to menstruate. Expert Rev Hematol 2023; 16:71-86. [PMID: 36920864 PMCID: PMC10020871 DOI: 10.1080/17474086.2023.2175660] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND People who have or had the potential to menstruate (PPM) with inherited bleeding disorders (BD) face particular challenges receiving appropriate diagnosis and care and participating in research. As part of an initiative to create a National Research Blueprint for future decades of research, the National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive all-stakeholder consultations to identify the priorities of PPM with inherited BDs and those who care for them. RESEARCH DESIGN AND METHODS Working group (WG) 4 of the NHF State of the Science Research Summit distilled community-identified priorities for PPM with inherited BDs into concrete research questions and scored their feasibility, impact, and risk. RESULTS WG4 identified important gaps in the foundational knowledge upon which to base optimal diagnosis and care for PPM with inherited BDs. They defined 44 top-priority research questions concerning lifespan sex biology, pregnancy and the post-partum context, uterine physiology and bleeding, bone and joint health, health care delivery, and patient-reported outcomes and quality-of-life. CONCLUSIONS The needs of PPM will best be advanced with research designed across the spectrum of sex and gender biology, with methodologies and outcome measures tailored to this population, involving them throughout.
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Affiliation(s)
- Maureen K. Baldwin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Homa K. Ahmadzia
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Vidhi Desai
- CSL Behring, King of Prussia, Pennsylvania, USA
| | - Kristina M. Haley
- The Hemophilia Center, Oregon Health and Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Sherry L. Herman-Hilker
- Hemophilia and Coagulation Disorders Program, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Roshni Kulkarni
- MSU Center of Bleeding and Clotting Disorders, Department Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - Shari Luckey
- Hemophilia Foundation of Michigan, Ypsilanti, Michigan, USA
| | - Kristen A. Matteson
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kristin Paulyson-Nuñez
- Duke Health Women & Children’s Services, Duke University Health Systems, Durham, North Carolina, USA
| | - Claire S. Philipp
- Division of Hematology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Kimberly Rosen
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | | | - Angela C. Weyand
- Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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16
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Côté M, Genest C, Richard E, Lemyre M, Laberge PY, Maheux-Lacroix S. Evaluation of a Standardized Questionnaire for Initial Assessment of Abnormal Uterine Bleeding in Premenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1136-1142. [PMID: 35934302 DOI: 10.1016/j.jogc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effect of a standardized questionnaire for premenopausal women with abnormal uterine bleeding (AUB) on clinical information collection and duration of consultation. METHODS We conducted a before and after study involving 100 premenopausal women undergoing consultation for AUB. During stage 1, 50 consultations were recorded on a consultation sheet with no specific template. During stage 2, 50 women completed a 26-item auto-administered standardized questionnaire before the consultation, which was then reviewed with the consultant and added to the medical record. The duration of consultation was assessed in subgroups of 27 women in each stage. Two independent evaluators assessed the quality and completeness of data collected in the medical records using a score sheet developed by experts. Outcomes from both stages were compared using the t test. RESULTS The descriptive characteristics were similar in both groups. The mean global scores of the quality and completeness of data collected improved significantly between stages 1 and 2, from 67% ± 12% to 95% ± 5% (P < 0.0001), as did medical background scores (54% ± 29% vs. 85% ± 13%; P < 0.0001) and AUB-related symptoms scores (69% ± 13% vs. 97% ± 5%; P < 0.0001). A mean reduction in duration of consultation of nearly 4 minutes was observed (24.6 ± 4.3 min vs. 20.7 ± 4.8 min; P < 0.0001). CONCLUSION The AUB-specific standardized questionnaire improves quality and completeness of data collected in medical records and reduces duration of consultation.
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Affiliation(s)
- Marille Côté
- Faculty of Medicine, Université Laval, Québec, QC; CHU de Québec, Université Laval, Québec, QC
| | - Carolanne Genest
- Faculty of Medicine, Université Laval, Québec, QC; Faculty of Medicine, Université de Montréal, Montréal, QC
| | - Evelynne Richard
- Faculty of Medicine, Université de Montréal, Montréal, QC; Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Madeleine Lemyre
- CHU de Québec, Université Laval, Québec, QC; Department of Obstetrics, Gynecology, and Reproduction, Québec, QC; CHU de Québec-Université Laval Research Center, Québec, QC
| | - Philippe Y Laberge
- CHU de Québec, Université Laval, Québec, QC; Department of Obstetrics, Gynecology, and Reproduction, Québec, QC; CHU de Québec-Université Laval Research Center, Québec, QC
| | - Sarah Maheux-Lacroix
- CHU de Québec, Université Laval, Québec, QC; Department of Obstetrics, Gynecology, and Reproduction, Québec, QC; CHU de Québec-Université Laval Research Center, Québec, QC.
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17
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Baena-García L, Aparicio VA. Author response to comment on: Premenstrual and menstrual changes reported after COVID-19 vaccination: The EVA project. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221129411. [PMID: 36217666 PMCID: PMC9551672 DOI: 10.1177/17455057221129411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura Baena-García
- Department of Nursing, Faculty of
Health Sciences, University of Granada, Ceuta, Spain,Sport and Health University Research
Institute (iMUDS), Granada, Spain,Laura Baena-García, Department of Nursing,
Faculty of Health Sciences, University of Granada, Ceuta, 51001, Spain.
| | - Virginia A Aparicio
- Sport and Health University Research
Institute (iMUDS), Granada, Spain,Institute of Nutrition and Food
Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada,
Granada, Spain,Department of Physiology, Faculty of
Pharmacy, University of Granada, Granada, Spain
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18
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Vannuccini S, Jain V, Critchley H, Petraglia F. From menarche to menopause, heavy menstrual bleeding is the underrated compass in reproductive health. Fertil Steril 2022; 118:625-636. [PMID: 36075746 DOI: 10.1016/j.fertnstert.2022.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 01/13/2023]
Abstract
Menstruation is defined as monthly uterine bleeding, regarded as a sign of reproductive health. When characterized by excessive bleeding (heavy menstrual bleeding [HMB]), it may act as a useful clinical marker for diagnosis of reproductive diseases. Endometrial and myometrial mechanisms underlying abnormal uterine bleeding (AUB), which includes HMB, have hormonal, cellular, and molecular aspects. Structural and nonstructural causes of AUB, presenting with HMB as the major symptom, result in iron depletion and consequent anemia. Heavy menstrual bleeding can be considered as a single entity to identify the possible underlying causes, which may be different to some extent to those of AUB, as a whole. Furthermore, the difficulties in defining HMB through objective methods do not allow the current epidemiological scenario on the prevalence of the symptom among reproductive-age women to be outlined. Moreover, the introduction of new diagnostic methods, including imaging technologies, entails a revision of the available figures on HMB in different age groups from menarche to menopause. In addition, a proper diagnostic algorithm for HMB should be implemented to adapt recommendations for clinical investigation when HMB is present.
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Affiliation(s)
- Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Varsha Jain
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Hilary Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, Scotland
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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19
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Zhang H, Yu S. Ultrasound-guided microwave ablation for symptomatic adenomyosis: More areas of concern for more uniform and promising outcomes. J Interv Med 2022; 5:122-126. [PMID: 36317146 PMCID: PMC9617158 DOI: 10.1016/j.jimed.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 12/07/2022] Open
Abstract
Adenomyosis is a common gynecological disease in reproductive women, which causes serious dysmenorrhea, menorrhagia, anemia, and infertility, and has a serious impact on the physical and mental health of women. Considering that the efficacy of the traditional medication and surgical treatment is not ideal, an increasing number of patients are searching for more effective and less invasive therapies. Ultrasound (US)-guided microwave ablation (MWA) has emerged as a new effective and minimally invasive alternative treatment for symptomatic adenomyosis, and it is widely being used in clinical settings. Several studies have proven that it is an efficient and safe treatment modality for symptomatic adenomyosis, but a significant variance in clinical outcomes reported in previous studies was also observed. Herein, we have analyzed the potential causes of this problem from the aspects of the diagnosis of adenomyosis, symptom evaluation before ablation, steps of US-guided ablation treatment, and outcome evaluation after ablation. Simultaneously, the clinical problems existing in the ablation treatment of adenomyosis are discussed, and the directions of future research are pointed out.
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20
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Badenhorst CE, Forsyth AK, Govus AD. A contemporary understanding of iron metabolism in active premenopausal females. Front Sports Act Living 2022; 4:903937. [PMID: 35966107 PMCID: PMC9366739 DOI: 10.3389/fspor.2022.903937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Iron metabolism research in the past decade has identified menstrual blood loss as a key contributor to the prevalence of iron deficiency in premenopausal females. The reproductive hormones estrogen and progesterone influence iron regulation and contribute to variations in iron parameters throughout the menstrual cycle. Despite the high prevalence of iron deficiency in premenopausal females, scant research has investigated female-specific causes and treatments for iron deficiency. In this review, we provide a comprehensive discussion of factors that influence iron status in active premenopausal females, with a focus on the menstrual cycle. We also outline several practical guidelines for monitoring, diagnosing, and treating iron deficiency in premenopausal females. Finally, we highlight several areas for further research to enhance the understanding of iron metabolism in this at-risk population.
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Affiliation(s)
- Claire E. Badenhorst
- School of Sport, Exercise, and Nutrition, College of Health, Massey University, Auckland, New Zealand
- *Correspondence: Claire E. Badenhorst
| | - Adrienne K. Forsyth
- School of Behavioural and Health Science, Australian Catholic University, Fitzroy, VIC, Australia
| | - Andrew D. Govus
- Discipline of Sport and Exercise, Department of Sport, Exercise, and Nutrition Science, La Trobe University, Melbourne, VIC, Australia
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21
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Dijk WEM, Punt MC, Galen KPM, Leeuwen J, Lely AT, Schutgens REG. Menstrual problems in chronic immune thrombocytopenia: A monthly challenge ‐ a cohort study and review. Br J Haematol 2022; 198:753-764. [PMID: 35662003 PMCID: PMC9540539 DOI: 10.1111/bjh.18291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/15/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
Immune thrombocytopenia (ITP) may cause menstrual problems. This cross‐sectional study assessed menstrual problems in premenopausal chronic ITP women by several questionnaires, including the pictorial bleeding assessment calendar (PBAC; score ≥100 indicates heavy menstrual bleeding [HMB]), and the menorrhagia multiattribute scale (MMAS). Spearman was used for assessing correlations. A literature review was performed in Pubmed. The cohort comprised 37 women (mean age 31 ± 9). A total of 29/37 (78%) had experienced clinical menstrual problems in the present or past. Of the 33 patients who returned the PBAC, 13 (39%) had a score of ≥100. The median MMAS score was 79 (IQR 60–95). The PBAC scores correlated with the MMAS. Both questionnaires were unrelated to the platelet count. Patients with a levonorgestrel intrauterine device (LNG‐IUD) had lower PBAC scores than patients with other or no hormonal therapy. MMAS scores were correlated with fatigue. The review identified 14 papers. HMB occurred in 6%–55% at ITP diagnosis and 17%–79% during disease. Menstrual symptoms influenced the quality of life, particularly in patients with a low platelet count. This explorative study suggested that HMB is frequent in women with chronic ITP despite management and platelet counts >50 *109/l. An LNG‐IUD seemed to reduce blood loss significantly.
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Affiliation(s)
- Wobke E. M. Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Marieke C. Punt
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Karin P. M. Galen
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Jeanette Leeuwen
- Division of Woman and Baby University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - A. Titia Lely
- Division of Woman and Baby University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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22
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Moisidis-Tesch CM, Shulman LP. Iron Deficiency in Women's Health: New Insights into Diagnosis and Treatment. Adv Ther 2022; 39:2438-2451. [PMID: 35488139 DOI: 10.1007/s12325-022-02157-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 02/08/2023]
Abstract
Iron deficiency (ID), with or without anemia, is commonly found worldwide and affects the health and wellbeing of pregnant and nonpregnant women. Symptoms of ID- which include fatigue, pica (ice craving), restless legs syndrome, poor concentration and work function, increased susceptibility to infection, and cardiovascular stress- can cause significant morbidity and reduced quality of life. The etiologies of iron deficiency in women are usually specific to each community. In the developing world, iron deficiency is usually associated with poor iron intake and parasitic infections, whereas in higher income regions, iron deficiency is typically the result of heavy, abnormal uterine bleeding, and pregnancy. Iron-poor diets and poor iron absorption resulting from gut disorders can also play a role. Diagnosis of iron deficiency is usually straightforward and characterized by a low ferritin level; however, the diagnosis can be challenging in women with concomitant inflammatory disorders, in which case a low percent transferrin saturation, performed after an overnight fast, can inform on the need for iron. Therapy is frequently initiated with oral iron salts; however, use of these oral regimens is commonly associated with adverse events, mostly gastrointestinal in nature, that have been shown to adversely impact compliance, continuation, and the achievement of therapeutic goals. A further impediment to the effectiveness of oral iron is its poor absorption because of comorbidity (i.e., celiac disease, gastritis, etc.), surgery (bariatric), or physiologic inhibitory mechanisms. As such, intravenous (IV) iron regimens are increasingly being used to treat ID, as such regimens have been shown to avoid the gastrointestinal adverse events commonly associated with oral regimens. Indeed, IV iron has been shown to provide adequate iron replacement in women with functional iron deficiencies as well as those with ID resulting from inflammatory disorders- patients often resistant to oral iron therapy. More recent IV iron regimens have been shown to provide iron replacement in a safe and effective manner, being associated with more salutary adverse event profiles than earlier IV iron regimens. In fact, these iron regimens can provide a complete replacement dose in a single 15-60-min visit.
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Stewart EA, Archer DF, Owens CD, Barnhart KT, Bradley LD, Feinberg EC, Gillispie-Bell V, Imudia AN, Liu R, Kim JH, Al-Hendy A. Reduction of Heavy Menstrual Bleeding in Women Not Designated as Responders to Elagolix Plus Add Back Therapy for Uterine Fibroids. J Womens Health (Larchmt) 2022; 31:698-705. [PMID: 34582715 PMCID: PMC9133968 DOI: 10.1089/jwh.2021.0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess outcomes of women with uterine fibroids (UFs) and heavy menstrual bleeding (HMB) treated with 300 mg elagolix twice daily plus add-back therapy (E2 1 mg/NETA 0.5 mg once daily) or placebo who were not considered responders in pooled analysis of two phase 3, 6-month randomized clinical trials (Elaris UF-1 and UF-2). Methods: Responders were defined as women who met both primary end point bleeding criteria (<80 mL menstrual blood loss [MBL] during the final month and ≥50% reduction in MBL from baseline to the final month) and either completed the study or discontinued due to predefined reasons. Thus, women termed nonresponders who were analyzed in this study who met neither or one bleeding end point or met both criteria but prematurely discontinued treatment because of adverse events, perceived lack of efficacy, or required surgical or interventional treatment for UFs were analyzed in this study. This post hoc analysis assessed mean changes from baseline in MBL, as well as adverse events. Results: Among 367 women receiving elagolix with add-back with observed data, 89 (24%) were not considered responders. Within this subset, 17 (19%) women met both bleeding criteria but prematurely discontinued treatment for the reasons mentioned above, while 23 (26%) met one bleeding criterion and 49 (55%) met neither bleeding criteria, regardless of discontinuation status. Among all nonresponders, a numerical trend toward greater mean reductions in MBL was observed in those receiving elagolix with add-back, compared with placebo group nonresponders. No differences in adverse events were observed between responders and nonresponders. Conclusion: Forty of 89 (45%) women with HMB and UFs who were classified as nonresponders in the UF-1 or UF-2 trials may have had a clinically meaningful response to elagolix with add-back therapy because they met at least one of the objective bleeding criteria. Clinical Trial Registration: Clinicaltrials.gov, NCT02654054 and NCT02691494. (NEJM 2020; 382:328-340) DOI: 10.1056/NEJMoa1904351.
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Affiliation(s)
- Elizabeth A. Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology and Surgery, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | - Kurt T. Barnhart
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda D. Bradley
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eve C. Feinberg
- Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | | | - Anthony N. Imudia
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ran Liu
- AbbVie, Inc., North Chicago, Illinois, USA
| | - Jin Hee Kim
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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Recommendations for standardization of bleeding data analyses in contraceptive studies. Contraception 2022; 112:14-22. [DOI: 10.1016/j.contraception.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
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Development of an algorithm to assess unmeasured symptom severity in gynecologic care. Am J Obstet Gynecol 2022; 226:388.e1-388.e11. [PMID: 34752734 PMCID: PMC8916977 DOI: 10.1016/j.ajog.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare disparities research is often limited by incomplete accounting for differences in health status by populations. In the United States, hysterectomy shows marked variation by race and geography, but it is difficult to understand what factors cause these variations without accounting for differences in the severity of gynecologic symptoms that drive the decision-making for hysterectomy. OBJECTIVE This study aimed to demonstrate a method for using electronic health record-derived data to create composite symptom severity indices to more fully capture relevant markers that influence the decision for hysterectomy. STUDY DESIGN This was a retrospective cohort study of 1993 women who underwent hysterectomy between April 4, 2014, and December 31, 2017, from 10 hospitals and >100 outpatient clinics in North Carolina. Electronic health record data, including billing, pharmacy, laboratory data, and free-text notes, were used to identify markers of 3 common indications for hysterectomy: bulk symptoms (pressure from uterine enlargement), vaginal bleeding, and pelvic pain. To develop weighted symptom indices, we finalized a scoring algorithm based on the relationship of each marker to an objective measure, in combination with clinical expertise, with the goal of composite symptom severity indices that had sufficient variation to be useful in comparing different patient groups and allow discrimination among severe symptoms of bulk, bleeding, or pain. RESULTS The ranges of symptom severity scores varied across the 3 indices, including composite bulk score (0-14), vaginal bleeding score (0-44), and pain score (0-30). The mean values of each composite symptom severity index were greater for those who had diagnostic codes for vaginal bleeding, bulk symptoms, or pelvic pain, respectively. However, each index demonstrated a variation across the entire group of hysterectomy cases and identified symptoms that ranged in severity among those with and without the target diagnostic codes. CONCLUSION Leveraging multisource data to create composite symptom severity indices provided greater discriminatory power to assess common gynecologic indications for hysterectomy. These methods can improve the understanding in healthcare use in the setting of long-standing inequities and be applied across populations to account for previously unexplained variations across race, geography, and other social indicators.
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Abstract
Regular health monitoring can result in early detection of disease, accelerate the delivery of medical care and, therefore, considerably improve patient outcomes for countless medical conditions that affect public health. A substantial unmet need remains for technologies that can transform the status quo of reactive health care to preventive, evidence-based, person-centred care. With this goal in mind, platforms that can be easily integrated into people's daily lives and identify a range of biomarkers for health and disease are desirable. However, urine - a biological fluid that is produced in large volumes every day and can be obtained with zero pain, without affecting the daily routine of individuals, and has the most biologically rich content - is discarded into sewers on a regular basis without being processed or monitored. Toilet-based health-monitoring tools in the form of smart toilets could offer preventive home-based continuous health monitoring for early diagnosis of diseases while being connected to data servers (using the Internet of Things) to enable collection of the health status of users. In addition, machine learning methods can assist clinicians to classify, quantify and interpret collected data more rapidly and accurately than they were able to previously. Meanwhile, challenges associated with user acceptance, privacy and test frequency optimization should be considered to facilitate the acceptance of smart toilets in society.
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Affiliation(s)
- Savas Tasoglu
- Department of Mechanical Engineering, Koc University, Istanbul, Turkey. .,Koç University Translational Medicine Research Center (KUTTAM), Koç University, Sarıyer, Istanbul, Turkey. .,Boğaziçi Institute of Biomedical Engineering, Boğaziçi University, Çengelköy, Istanbul, Turkey. .,Physical Intelligence Department, Max Planck Institute for Intelligent Systems, Stuttgart, Germany.
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Arbeláez-Gómez D, Benavides-López S, Giraldo-Agudelo MP, Guzmán-Álvarez JP, Ramirez-Mazo C, Gómez-Echavarría LM. A phenomenological-based model of the endometrial growth and shedding during the menstrual cycle. J Theor Biol 2022; 532:110922. [PMID: 34582826 DOI: 10.1016/j.jtbi.2021.110922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
The human endometrium presents a remarkable growth dynamic with an outstanding regenerative capacity. This work aims to develop a phenomenological-based dynamic model to predict the volume changes in the functional layer of the endometrium in each phase of the menstrual cycle. This model considers changes in the endometrial tissue, the blood flow through the spiral arteries, the shedding of the endometrial cells, and the menstrual blood flow. The input variables are estrogen and progesterone; these hormone dynamics are taken from a pre-existing and validated model. Key parameters are modified in order to know their effect on the state variables. The model response was quantitatively assessed using the experimental data of the endometrial cycle reported in the literature. The proposed model provides a better insight into the interactions between ovarian hormones and the endometrial cycle by coupling both physiological processes.
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Affiliation(s)
- Daniela Arbeláez-Gómez
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
| | - Santiago Benavides-López
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
| | - Maria Paula Giraldo-Agudelo
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
| | - Juan Pablo Guzmán-Álvarez
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
| | - Carolina Ramirez-Mazo
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
| | - Lina María Gómez-Echavarría
- Universidad Nacional de Colombia, Facultad de Minas, Escuela de Procesos y Energia, Grupo de Investigacion en Procesos Dinamicos KALMAN, Cra 80 No 65-223, Medellin 050041, Colombia.
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Dutta S, Karkada IR, Sengupta P, Chinni SV. Anthropometric Markers With Specific Cut-Offs Can Predict Anemia Occurrence Among Malaysian Young Adults. Front Physiol 2021; 12:731416. [PMID: 34603084 PMCID: PMC8481777 DOI: 10.3389/fphys.2021.731416] [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: 06/27/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: Anemia bears a high global prevalence with about 1.6 billion people living with this affliction. Malaysia carries the burden of 13.8% anemia prevalence which urges for extensive research directed to its prediction and amelioration. This is the first study that aims to (a) propose simple non-invasive predictive anthropometric markers and their specific cut-off values for early prediction of anemia among the young adults in Malaysia, (b) provide anemia prevalence based on both gender and ethnicity among young adults of Malaysia. Method: The present cross-sectional study included 245 participants (113 men and 132 women) aged between 18 and 30 years. Anthropometric parameters were measured following the standard protocols. Blood samples were collected and hemoglobin levels were determined using the HemoCue haemoglobinometer (Hb 201+ System, Angelhom, Sweden) to detect the presence of anemia. The receiver operating characteristics (ROC) curve was employed to assess and compare the efficacy of anthropometric indices in the prediction of anemia. Data were analyzed using SPSS (v. 22.0, IBM, Chicago, IL, USA) and MedCalc (v. 19.05, Ostend, Belgium). Result: The ROC analysis indicates that body mass index (BMI) is the best anthropometric marker with the highest area under the curve (AUC) and specificity (SP) for predicting the presence of anemia in young adults in Malaysia. Thus, the study proposes the optimal cut-off value of BMI for young men of Malaysia as 20.65 kg/m2 (AUC: 0.889) and young women of Malaysia as 19.7 kg/m2 (AUC: 0.904). The study also reports that Malaysian Indians have the highest prevalence of anemia (26.22%) followed by Malays (21.54%), “Others” (indigenous ethnic group) (20%), and Chinese (14.5%), with an overall higher prevalence of anemia in young adult women (21.96%) than in men (18.6%) of Malaysia. Conclusion: The proposed anemia-predictive anthropometric markers with optimal cut-off values will aid early detection of anemia among young adults in Malaysia, and given its simple, inexpensive, and intelligible approach, it can be widely used. The ease of anemia prediction together with the reported distribution of anemia prevalence based on gender and ethnicity will facilitate in gauging the necessary extent of strategies of anemia management in the young adult population of Malaysia.
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Affiliation(s)
- Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarum, Malaysia
| | - Ivan Rolland Karkada
- Physiology Unit, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarum, Malaysia
| | - Pallav Sengupta
- Physiology Unit, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarum, Malaysia
| | - Suresh V Chinni
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Bedong, Malaysia
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Rahman S, Khan FS, Samin KA, Afridi N, Ahmed M. Efficacy of Oral Tranexamic Acid Versus Combined Oral Contraceptives for Heavy Menstrual Bleeding. Cureus 2021; 13:e19122. [PMID: 34858760 PMCID: PMC8614172 DOI: 10.7759/cureus.19122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Heavy menstrual bleeding (HMB) is characterized by high blood loss (>80 mL per cycle) at regular menstrual intervals. It can have an impact on a woman's bodily, mental, and/or material well-being. The etiology is varied and can be local, systemic, or iatrogenic. The occurrence of HMB is between 4% and 27%, depending on objective menstrual bleeding measurements and on high estimates based on subjective bleeding measures. This study was conducted to assess the efficacy of oral tranexamic acid versus combined oral contraceptive (COC) pills in the management of excessive menstrual bleeding. Methodology A comparative study was conducted at the Obstetrics and Gynecology Department of Combined Military Hospital Peshawar, Pakistan, from October 2020 to March 2021. Women aged above 18 years who presented with heavy menstrual bleeding (HMB) were included in the study. The exclusion criteria included all women with contraindications to the use of tranexamic acid, such as lactating mothers, pregnancy, use of oral contraceptives or steroids, history of renal malfunction or stroke, family history of thromboembolic disease, and ovarian or endometrial carcinoma. Patients with diagnosed leiomyomas with a size between >1 and 10 cm were included in the study. Women were allocated randomly into group A who received oral tranexamic acid 3.9-4 g per day or group B who received oral COC pills containing a combination of ethinyl estradiol 30 μg and norgestrel 0.3 mg. The efficacy of treatment was considered successful if there was a mean reduction in menstrual blood loss that was significantly greater than the baseline values. Results There were 178 patients in total, with 89 patients in each group. It was found that both oral tranexamic acid and combined oral contraceptives were equally effective in reducing the mean blood loss among patients and there was no statistical difference observed between the two groups. Upon stratification, it was found that both treatment groups were highly effective in younger age groups. Similarly, there was no significant difference in efficacy with respect to diabetes mellitus or hypertension. However, in individuals with leiomyomas, efficacy was significantly higher in patients who were in group B (combined oral contraceptives) (p = 0.004), and 46.1% of women in group A and 60.6% of women in group B did not experience any discomfort. Conclusion The current study revealed that both oral tranexamic acid and COC pills were equally effective in reducing the mean blood loss among patients with HMB. It was further found that the efficacy of both therapies was significantly higher in younger age groups. The efficacy of therapy was significantly reduced with the increasing age of the patient. Moreover, it was found that patients with leiomyomas benefitted more significantly from COC pills. There were no severe adverse effects reported in the study. However, future researches can explore the long-term side effects of both therapies. In short, both therapies were comparable in terms of efficacy and safety. Heavy menstrual bleeding can negatively impact a woman, emotionally and physically. Therefore, it is encouraged that physicians use their expert judgment while prescribing either oral tranexamic acid or COC pills to patients with HMB.
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Affiliation(s)
- Sundus Rahman
- Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Peshawar, PAK
| | - Fatima S Khan
- Department of Obstetrics and Gynecology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK
| | - Kashif A Samin
- Department of Family Medicine, Khyber Medical University, Peshawar, PAK
| | - Nighat Afridi
- Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Peshawar, PAK
| | - Moiz Ahmed
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Wang Z, Yang M, Mao L, Wang X, Wang S, Cui G, Hou Z, Yang M, Cui L, Bai W. Efficacy and safety of autologous platelet-rich fibrin for the treatment of infertility with intrauterine adhesions. J Obstet Gynaecol Res 2021; 47:3883-3894. [PMID: 34482587 DOI: 10.1111/jog.14964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 12/26/2022]
Abstract
AIM To evaluate the efficacy and safety of autologous platelet-rich fibrin (PRF) for the treatment of infertility with intrauterine adhesions. METHODS Forty patients who suffered from infertility with intrauterine adhesions (IUAs) were enrolled in this prospective trial from October 2018 to December 2019. They were randomly divided into a PRF group and a control group. Both groups underwent transcervical resection of adhesions (TCRA) during the follicular phase. PRF group: PRF prepared from autologous venous blood was placed in the uterine cavity after TCRA and after the first menstrual re-fluid; control group: no PRF insertion. After the second menstrual re-fluid, both groups underwent hysteroscopy to reevaluate adhesion severity. Pregnancy rate, intrauterine adhesion score, menstrual volume and duration, and endometrial thickness were assessed and adverse events were recorded. RESULTS (1) PRF group pregnancy rate was significantly higher than the control group (55.0% vs. 20.0%). Mean follow-up time was (17.63 ± 2.33) months. All patients fell pregnant naturally. Four (PRF) and one (control) patients delivered live births without placental complications. (2) Intrauterine adhesion scores decreased compared with treatment-before. (3) In the pictorial blood loss assessment chart, score and menstrual duration during the 3rd menstrual cycle showed significant improvements for both groups. (4) Endometrial thickness also showed an increasing trend, and subendometrial bloodflow improved. (5) No treatment-related serious adverse events were noted. CONCLUSION Placing PRF into the uterine cavity of infertility patients with IUAs following TCRA is a safe and effective therapeutic method.
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Affiliation(s)
- Zijun Wang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mukun Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lele Mao
- Department of Obstetrics and Gynecology, Xiehe Hospital, Tongji Medical University, Wuhan, China
| | - Xiaoxue Wang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shuowen Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Guangxia Cui
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhaoxi Hou
- Department of Obstetrics and Gynecology, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Min Yang
- Department of Ultrasonography, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lei Cui
- Department of Plastic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wenpei Bai
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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van Galen K, Lavin M, Skouw-Rasmussen N, Fischer K, Noone D, Pollard D, Mauser-Bunschoten E, Khair K, Gomez K, van Loon E, Bagot CN, Elfvinge P, d'Oiron R, Abdul-Kadir R. European principles of care for women and girls with inherited bleeding disorders. Haemophilia 2021; 27:837-847. [PMID: 34343384 DOI: 10.1111/hae.14379] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Despite increasing awareness of issues faced by women and girls with inherited BDs (WGBD), standards of care are lacking, with disparities in diagnosis and treatment for WGBD across Europe. We aimed to develop practical principles of care (PoC) to promote standardization of care for WGBD within European Haemophilia Treatment and Comprehensive Care Centres (HTC/CCCs). METHODS The co-creation process, supported by the European Association for Haemophilia and Allied Disorders, consisted of four multidisciplinary meetings with health care providers (HCPs) experienced in WGBD care, and European Haemophilia Consortium representatives, combined with broad patient and HCP consultations in the European haemophilia community. Relevant medical societies outside Europe were contacted for confirmation. RESULTS We developed ten PoC for WGBD, stressing the importance and benefits of a centralized, multidisciplinary, comprehensive, family-centred approach to support and manage WGBD during all life stages. These PoC emphasise the right to equitable access and quality of care for all people with BDs, irrespective of gender. Multiple medical societies outside Europe also confirmed their support for endorsement. CONCLUSIONS Ten PoC for WGBD evolved from an iterative process among stakeholders, supported by relevant medical societies worldwide. These PoC can serve as a benchmark for diagnosis and comprehensive multidisciplinary management of WGBD, and improve awareness of their unique challenges. They offer a framework to guide HTC/CCCs in providing equitable care for all WGBD, both in their own services and in other healthcare settings. Implementation of these principles aims to positively impact the health, wellbeing and quality of life for WGBD.
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Affiliation(s)
- Karin van Galen
- Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomedical Sciences, RCSI, Dublin and National Coagulation Centre, St. James' Hospital, Dublin, Ireland
| | | | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Declan Noone
- President, European Haemophilia Consortium, Brussels, Belgium
| | - Debra Pollard
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | | | - Kate Khair
- Director of Research, Haemnet, London, UK
| | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Petra Elfvinge
- Department of Haematology, Karolinska University, Stockholm, Sweden
| | - Roseline d'Oiron
- Centre de Référence de l'Hémophilie et des Maladies Hémorragiques Constitutionnelles, APHP Paris Saclay - Hôpital Bicêtre and Inserm, U 1176 Le Kremlin Bicêtre, France
| | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology, Royal Free London NHS Foundation Trust and Institute for Women's Health, University College London, London, UK
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Brache V, Vieira CS, Plagianos M, Lansiaux M, Merkatz R, Sussman H, Cochon L, Tejada AS, Kumar N, Loeven D, Blithe DL, Aprem AS, Williams AR, Kannan A, Bagchi IC, Sitruk-Ware R. Pharmacodynamics and pharmacokinetics of a copper intrauterine contraceptive system releasing ulipristal acetate: A randomized proof-of-concept study. Contraception 2021; 104:327-336. [PMID: 34157312 DOI: 10.1016/j.contraception.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess pharmacodynamic and pharmacokinetic outcomes of a novel copper (Cu) intrauterine system (IUS) releasing ulipristal acetate (UPA) in healthy women. STUDY DESIGN In this single-blinded, randomized proof-of-concept study, ovulatory women received one of three Cu-IUSs releasing low-dose UPA (5, 20 or 40 µg/d) for 12 weeks. The study included a baseline cycle, three 4-week treatment-cycles and 2 recovery cycles. Primary outcomes included effects of the IUS on bleeding profile, ovarian function, and the occurrence of progesterone receptor modulator associated endometrial changes (PAEC). Pharmacokinetics and safety profile were secondary outcomes. We compared outcomes in treatment-cycle 3 with baseline, using generalized linear mixed models with orthogonal contrasts. RESULTS We randomized 29 women (5 µg/d = 10, 20 µg/d = 10, 40 µg/d = 9). All had a successful IUS insertion; 27 completed the 12-week treatment period. Compared to baseline, the mean number of bleeding-only days at treatment-cycle 3 declined by 16.7% in the 5 µg/d group (3.6 vs 3.0, p = 0.66), 40.5% in the 20 µg/d group (4.2 vs 2.5, p = 0.14), and 77% in the 40 µg/d group (3.9 vs 0.9, p = 0.002). Most women reported reduction in the amount of bleeding: 4/8, 8/10, and 7/9 for the 5 µg/d, 20 µg/d, and 40 µg/d groups, respectively. During IUS use, ovulation occurred in most cycles [5 µg/d: 23/24 (96%), 20 µg/d: 26/30 (87%), 40 µg/d: 22/27 (81%)]. The frequency of PAEC at IUS removal was 1/10 (10%), 1/10 (10%) and 4/9 (44%) in the 5 µg/d, 20 µg/d, and 4 0 µg/d groups, respectively. No serious adverse events occurred. CONCLUSIONS Reduction in bleeding, low incidence of PAEC, and no serious adverse events are reassuring findings of the novel Cu-UPA-IUS. The 20 µg/d seems the lowest dose promoting a favorable bleeding profile and limiting PAEC. IMPLICATIONS The preliminary results of this short-term study of a novel copper intrauterine system (IUS) delivering ulipristal acetate showed reduction of bleeding, low incidence of progesterone receptor modulator associated endometrial changes, and absence of serious adverse events. By preventing copper-induced increase in bleeding, this IUS could provide a noncontraceptive benefit, especially for women with low hemoglobin.
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Affiliation(s)
- Vivian Brache
- Investigaciones Biomédicas de Profamilia, Clínica Profamilia. Santo Domingo, Dominican Republic
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Maud Lansiaux
- Population Council, New York City, NY, United States
| | - Ruth Merkatz
- Population Council, New York City, NY, United States
| | | | - Leila Cochon
- Investigaciones Biomédicas de Profamilia, Clínica Profamilia. Santo Domingo, Dominican Republic
| | - Ana S Tejada
- Investigaciones Biomédicas de Profamilia, Clínica Profamilia. Santo Domingo, Dominican Republic
| | | | - Daniel Loeven
- Population Council, New York City, NY, United States
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | | | - Alistair Rw Williams
- Department of Pathology, The University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh
| | | | - Indrani C Bagchi
- University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Heavy menstrual bleeding and its detection in clinical practice. Med Clin (Barc) 2021; 157:332-338. [PMID: 33840528 DOI: 10.1016/j.medcli.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with quality of life. It is an under-diagnosed and under-treated disorder due to the poor correlation between patient perception and objective menstrual blood loss, as well as the scarcity of validated diagnostic tools. Anaemia caused by HMB is a common problem, underestimated on many occasions and with consequences that go beyond the scope of gynaecology. Despite the condition's negative effect on quality of life, most of the tools validated to detect HBM do not take this into account. The aim of this paper is to review the main instruments available to detect HMB, their advantages and disadvantages, their applicability in routine clinical practice, and to recommend those with the best characteristics.
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Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users. Obstet Gynecol Int 2021; 2021:2904542. [PMID: 33777145 PMCID: PMC7972863 DOI: 10.1155/2021/2904542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users. Methods A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants. Results A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Conclusion There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Implications. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns.
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Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding. Am J Obstet Gynecol 2021; 224:187.e1-187.e10. [PMID: 32795428 DOI: 10.1016/j.ajog.2020.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/30/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Heavy menstrual bleeding affects the physical functioning and social well-being of many women. The levonorgestrel-releasing intrauterine system and endometrial ablation are 2 frequently applied treatments in women with heavy menstrual bleeding. OBJECTIVE This study aimed to compare the effectiveness of the levonorgestrel-releasing intrauterine system with endometrial ablation in women with heavy menstrual bleeding. STUDY DESIGN This multicenter, randomized controlled, noninferiority trial was performed in 26 hospitals and in a network of general practices in the Netherlands. Women with heavy menstrual bleeding, aged 34 years and older, without a pregnancy wish or intracavitary pathology were randomly allocated to treatment with either the levonorgestrel-releasing intrauterine system (Mirena) or endometrial ablation, performed with a bipolar radiofrequency device (NovaSure). The primary outcome was blood loss at 24 months, measured with a Pictorial Blood Loss Assessment Chart score. Secondary outcomes included reintervention rates, patient satisfaction, quality of life, and sexual function. RESULTS We registered 645 women as eligible, of whom 270 women provided informed consent. Of these, 132 women were allocated to the levonorgestrel-releasing intrauterine system (baseline Pictorial Blood Loss Assessment Chart score, 616) and 138 women to endometrial ablation (baseline Pictorial Blood Loss Assessment Chart score, 630). At 24 months, mean Pictorial Blood Loss Assessment Chart scores were 64.8 in the levonorgestrel-releasing intrauterine system group and 14.2 in the endometrial ablation group (difference, 50.5 points; 95% confidence interval, 4.3-96.7; noninferiority, P=.87 [25 Pictorial Blood Loss Assessment Chart point margin]). Compared with 14 women (10%) in the endometrial ablation group, 34 women (27%) underwent a surgical reintervention in the levonorgestrel-releasing intrauterine system group (relative risk, 2.64; 95% confidence interval, 1.49-4.68). There was no significant difference in patient satisfaction and quality of life between the groups. CONCLUSION Both the levonorgestrel-releasing intrauterine system and endometrial ablation strategies lead to a large decrease in menstrual blood loss in women with heavy menstrual bleeding, with comparable quality of life scores after treatment. Nevertheless, there was a significant difference in menstrual blood loss in favor of endometrial ablation, and we could not demonstrate noninferiority of starting with the levonorgestrel-releasing intrauterine system. Women who start with the levonorgestrel-releasing intrauterine system, a reversible and less invasive treatment, are at an increased risk of needing additional treatment compared with women who start with endometrial ablation. The results of this study will enable physicians to provide women with heavy menstrual bleeding with the evidence to make a well-informed decision between the 2 treatments.
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Lorzadeh N, Kazemirad Y, Kazemirad N. The effect of corrective and therapeutic exercises on bleeding volume and severe menstrual pain in non-athletic women. J OBSTET GYNAECOL 2021; 41:1121-1126. [PMID: 33432852 DOI: 10.1080/01443615.2020.1839870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to determine the relationship between lumbar lordosis and severe menstrual pain and bleeding for the improvement of the health status in women. This was a quasi-experimental study where the effects of a training program, (based on correctional and therapeutic exercises, on primary dysmenorrhoea and menstrual bleeding in women with hyper-lordosis) was determined. The severity of menstrual pain was evaluated by use of a questionnaire. There was a significant incidence of neurological pain, which was not reduced in the control group (who had no exercise). There was a significant relationship between the severity of menstrual pain and hyper-lordosis. In the intervention group, there was a significant decrease in the severity of menstrual pain following 12 weeks of exercise. Hyper-lordosis can be improved by performing corrective exercises and strengthening the abdominal muscles.Impact statementWhat is already known on this subject? Exercise is positively associated with changes in the menstrual cycle and has beneficial effects on menstruation.What do the results of this study add? This research determines the relationship between lumbar lordosis and severe menstrual pain and the association of severe menstrual bleeding, in order to take effective corrective actions to improve women's health.What are the implications of these findings for clinical practice and/or further research? Hyper-lordosis can be improved by corrective exercises and strengthening of the abdominal muscles.
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Affiliation(s)
- Nahid Lorzadeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Nastran Kazemirad
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Hamulyák EN, Wiegers HMG, Scheres LJJ, Hutten BA, de Lange ME, Timmermans A, Westerweel PE, Nijziel MR, Kruip MJHA, ten Wolde M, Ypma PF, Klok FA, Nieuwenhuizen L, van Wissen S, Hovens MMC, Faber LM, Kamphuisen PW, Büller HR, Middeldorp S. Heavy menstrual bleeding on direct factor Xa inhibitors: Rationale and design of the MEDEA study. Res Pract Thromb Haemost 2021; 5:223-230. [PMID: 33537547 PMCID: PMC7845056 DOI: 10.1002/rth2.12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/19/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In premenopausal women, treatment with direct oral factor Xa inhibitors is associated with an increased risk of heavy menstrual bleeding (HMB) compared with vitamin K antagonists (VKA). Treatment with the direct oral thrombin inhibitor dabigatran appears to be associated with a reduced risk of HMB compared with VKA. These findings come from small observational studies or post hoc analyses of trials in which HMB was not a primary outcome. Use of tranexamic acid during the menstrual period may be effective in patients with HMB, but prospective data regarding efficacy and safety in patients on anticoagulant treatment are lacking. RATIONALE AND DESIGN A direct comparison of a factor Xa inhibitor and a thrombin inhibitor with HMB as primary outcome, as well as an evaluation of the effects of adding tranexamic acid in women with anticoagulant-associated HMB is highly relevant for clinical practice. The MEDEA study is a randomized, open-label, pragmatic clinical trial to evaluate management strategies in premenopausal women with HMB associated with factor Xa inhibitor therapy. OUTCOMES Women using factor Xa inhibitors with proven HMB, as assessed by a pictorial blood loss assessment chart (PBAC) score of >150, will be randomized to one of three study arms: (i) switch to dabigatran; (ii) continue factor Xa inhibitor with addition of tranexamic acid during the menstrual period; or (iii) continue factor Xa inhibitor without intervention. The primary outcome is the difference in PBAC score before and after randomization. Here, we present the rationale and highlight several unique features in the design of the study.
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Affiliation(s)
- Eva N. Hamulyák
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Hanke M. G. Wiegers
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Luuk J. J. Scheres
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Barbara A. Hutten
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Maria E. de Lange
- Department of Gynecology and ObstetricsAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anne Timmermans
- Department of Gynecology and ObstetricsAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Peter E. Westerweel
- Department of Internal MedicineAlbert Schweitzer HospitalDordrechtThe Netherlands
| | - Marten R. Nijziel
- Department of HematologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | | | - Marije ten Wolde
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Paula F. Ypma
- Department of HematologyHaga HospitalThe HagueThe Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and HaemostasisLeiden University Medical CentreLeidenThe Netherlands
| | | | | | | | - Laura M. Faber
- Department of Internal MedicineRed Cross HospitalBeverwijkThe Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Harry R. Büller
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
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Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther 2021; 38:201-225. [PMID: 33247314 PMCID: PMC7695235 DOI: 10.1007/s12325-020-01564-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022]
Abstract
Introduction Up to one-third of women of reproductive age experience heavy menstrual bleeding (HMB). HMB can give rise to iron deficiency (ID) and, in severe cases, iron-deficiency anemia (IDA). Aim To review current guidelines for the management of HMB, with regards to screening for anemia, measuring iron levels, and treating ID/IDA with iron replacement therapy and non-iron-based treatments. Methods The literature was searched for English-language guidelines relating to HMB published between 2010 and 2020, using the PubMed database, web searching, and retrieval of clinical guidelines from professional societies. Results Overall, 55 guidelines mostly originating from North America and Europe were identified and screened. Twenty-two were included in this review, with the majority (16/22) focusing on guidance to screen women with HMB for anemia. The guidance varied with respect to identifying symptoms, the criteria for testing, and diagnostic hemoglobin levels for ID/IDA. There was inconsistency concerning screening for ID, with 11/22 guidelines providing no recommendations for measurement of iron levels and four contrasting guidelines explicitly advising against initial assessment of iron levels. In terms of treatment, 8/22 guidelines provided guidance on iron therapy, with oral iron administration generally recommended as first-line treatment for ID and/or IDA. Four guidelines recommended intravenous iron administration for severe anemia, in non-responders, or before surgery. Three guidelines provided hemoglobin thresholds for choosing between oral or intravenous iron treatment. Four guidelines discussed the use of transfusion for severe IDA. Conclusion Many of the guidelines for managing HMB recognize the importance of treating anemia, but there is a lack of consensus in relation to screening for ID and use of iron therapy. Consequently, ID/IDA associated with HMB is likely to be underdiagnosed and undertreated. A consensus guidance, covering all aspects of screening and management of ID/IDA in women with HMB, is needed to optimize health outcomes in these patients. Women who bleed heavily during menstruation are at risk of iron deficiency and anemia. This can have a negative effect on the well-being of women and can cause serious complications after surgery. Iron is an important part of the hemoglobin in red blood cells that carries oxygen around the body. Bleeding causes iron to be lost from the body. If there is heavy blood loss, iron stores in the body can become low, leading to iron deficiency. If the iron deficiency is severe enough to impair red blood cell production, iron-deficiency anemia can develop. We reviewed the current guidelines for the care of women with heavy menstrual bleeding, focusing on the detection and treatment of iron deficiency and anemia. Most guidelines include routine testing for anemia. Fewer guidelines consider measuring iron levels. Not all the guidelines include advice on the best way to treat iron deficiency and anemia. For those that do, the recommendations vary and sometimes offer conflicting advice. There is little agreement on when to give iron therapy, and whether this should be given by mouth or by infusion. A lack of clear guidance on detecting and treating iron deficiency and anemia caused by heavy menstrual bleeding puts women at risk of being undiagnosed and untreated. To address these concerns, the authors recommend the development of consensus guidelines. These should contain comprehensive recommendations on all aspects of the diagnosis and management of iron deficiency and anemia in women with heavy menstrual bleeding.
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Haberland C, Filonenko A, Seitz C, Börner M, Gerlinger C, Doll H, Wessiepe D. Validation of a menstrual pictogram and a daily bleeding diary for assessment of uterine fibroid treatment efficacy in clinical studies. J Patient Rep Outcomes 2020; 4:97. [PMID: 33185783 PMCID: PMC7666240 DOI: 10.1186/s41687-020-00263-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the psychometric and measurement properties of two patient-reported outcome instruments, the menstrual pictogram superabsorbent polymer-containing version 3 (MP SAP-c v3) and Uterine Fibroid Daily Bleeding Diary (UF-DBD). Test-retest reliability, criterion, construct validity, responsiveness, missingness and comparability of the MP SAP-c v3 and UF-DBD versus the alkaline hematin (AH) method and a patient global impression of severity (PGI-S) were analyzed in post hoc trial analyses. RESULTS Analyses were based on data from up to 756 patients. The full range of MP SAP-c v3 and UF-DBD response options were used, with score distributions reflecting the cyclic character of the disease. Test-retest reliability of MP SAP-c v3 and UF-DBD scores was supported by acceptable intraclass correlation coefficients when stability was defined by the AH method and Patient Global Impression of Severity (PGI-S) scores (0.80-0.96 and 0.42-0.94, respectively). MP SAP-c v3 and UF-DBD scores demonstrated strong and moderate-to-strong correlations with menstrual blood loss assessed by the AH method. Scores increased in monotonic fashion, with greater disease severities, defined by the AH method and PGI-S scores; differences between groups were mostly statistically significant (P < 0.05). MP SAP-c v3 and UF-DBD were sensitive to changes in disease severity, defined by the AH method and PGI-S. MP SAP-c v3 and UF-DBD showed a lower frequency of missing patient data versus the AH method, and good agreement with the AH method. CONCLUSIONS This evidence supports the use of the MP SAP-c v3 and UF-DBD to assess clinical efficacy endpoints in UF phase III studies replacing the AH method.
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Affiliation(s)
- Claudia Haberland
- Market Access, Public Affairs & Sustainability, TA Pulmonology / Innovative WHC, Bayer AG, Building S157, 3.315, 13342, Berlin, Germany.
| | - Anna Filonenko
- Market Access, Public Affairs & Sustainability, TA Pulmonology / Innovative WHC, Bayer AG, Building S157, R318, 13342, Berlin, Germany
| | - Christian Seitz
- Research & Development, Pharmaceuticals, CD Gynecological Therapies, Bayer AG, Building P300, A422, 13342, Berlin, Germany
| | - Matthias Börner
- Statistical Analytics, Bayer AG, Building P300, A138, 13342, Berlin, Germany
| | - Christoph Gerlinger
- Statistics and Data Insights, Bayer AG, Building P300, A121, 13342, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Saar, Germany
| | - Helen Doll
- ICON Patient Centered Outcomes, London, UK.,Strategic Lead, Quantitative Science, Clinical Outcomes Solutions, Folkestone, UK
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Calaf J, Cancelo MJ, Andeyro M, Jiménez JM, Perelló J, Correa M, Parera N, Lete LI, Calvo A, Doval JL, Duarte R, García JL, Colomé C. Development and Psychometric Validation of a Screening Questionnaire to Detect Excessive Menstrual Blood Loss That Interferes in Quality of Life: The SAMANTA Questionnaire. J Womens Health (Larchmt) 2020; 29:1021-1031. [DOI: 10.1089/jwh.2018.7446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | | | | | | | - Marta Correa
- Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | - Andrés Calvo
- Hospital Quirónsalud Palmaplanas, Mallorca, Spain
| | - José Luis Doval
- Complexo Hospitalario Universitario de Ourense, Orense, Spain
| | | | | | - Clara Colomé
- Clínica de Reproducción Asistida y Fertilidad, IVI, Mallorca, Spain
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Souizi B, Akrami R, Borzoee F, Sahebkar M. Comparison of the efficacy of sublingual, oral, and vaginal administration of misoprostol in the medical treatment of missed abortion during first trimester of pregnancy: A randomized clinical trial study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:72. [PMID: 33088309 PMCID: PMC7554523 DOI: 10.4103/jrms.jrms_393_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/27/2019] [Accepted: 03/27/2020] [Indexed: 01/30/2023]
Abstract
Background: This study was aimed at comparing the efficacy of different routes of misoprostol administration, including sublingual, oral, and vaginal, on the induction of medical abortion in the first trimester of pregnancy. Materials and Methods: This open-label, randomized clinical trial study was performed on 172 individuals in three parallel groups of vaginal, sublingual, and oral administration of misoprostol. The participants were randomized using permuted blocks of six. A dose of 600 μg of misoprostol every 6 h (maximum of 4 doses) was administrated to each group. Higham chart and demographic questionnaires were completed by the investigator. Data were analyzed using Stata software version 12. Results: The mean age of the participants was 29.81 ± 6.7 years, and the mean gestational age was 8.45 ± 2.32 weeks. We found a significant difference regarding the abortion success rate and the time interval between the administration of the drug among three groups (P = 0.036 and < 0.001 in turn). There was no statistically significant difference between the three groups in terms of severity and duration of vaginal bleeding until day 7 after induction (P = 0.091 and 0.143, respectively). Furthermore, we found statistically significant differences in some drugs, which induced side effects namely vomiting and headache, between the three groups (P = 0.032 and 0.028 in turn). Conclusion: The findings suggest that vaginal administration of misoprostol is more successful than the sublingual and oral route for complete abortion; vaginal administration of misoprostol is an appropriate alternative to curettage.
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Affiliation(s)
- Behnaz Souizi
- Department of Obstetrics and Gynecology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Rahim Akrami
- Department of Community Medicine, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Fateme Borzoee
- Department of Operating Room, School of Paramedics, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Sahebkar
- Department of Social Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Bofill Rodriguez M, Lethaby A, Farquhar C, Duffy JM. Interventions commonly available during pandemics for heavy menstrual bleeding: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2020; 7:CD013651. [PMID: 32700364 PMCID: PMC7388826 DOI: 10.1002/14651858.cd013651.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Within the context of heavy menstrual bleeding, pandemics impact upon women's assessment and treatment by healthcare providers. OBJECTIVES To summarise the evidence from Cochrane Reviews evaluating interventions for heavy menstrual bleeding that are commonly available during pandemics. METHODS We sought published Cochrane Reviews, evaluating interventions that can continue during pandemics for women with heavy menstrual bleeding with no known underlying cause. We identified Cochrane Reviews by searching the Cochrane Database of Systematic Reviews in June 2020. The primary outcome was menstrual bleeding. Secondary outcomes included quality of life, patient satisfaction, side effects, and serious adverse events. We undertook the selection of systematic reviews, data extraction, and quality assessment in duplicate. We resolved any disagreements by discussion. We assessed review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool, and the certainty of the evidence for each outcome using GRADE methods. MAIN RESULTS We included four Cochrane Reviews, with 11 comparisons, data from 44 randomised controlled trials (RCTs), and 3196 women. We assessed all the reviews to be high quality. Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs may be more effective in reducing heavy menstrual bleeding than placebo (mean difference (MD) -124 mL per cycle, 95% confidence interval (CI) -186 to -62 mL per cycle; 1 RCT, 11 women; low-certainty evidence). Mefenamic acid may be similar to naproxen (MD 21 mL per cycle, 95% CI -6 to 48 mL per cycle; 2 RCTs, 61 women; low-certainty evidence), and NSAIDs may be similar to combined hormonal contraceptives for heavy menstrual bleeding (MD 25 mL per cycle, 95% CI -22 to 73 mL per cycle; 1 RCT, 26 women; low-certainty evidence). NSAIDs may be be less effective in reducing menstrual bleeding than antifibrinolytics (relative risk (RR) 0.70, 95% CI 0.58 to 0.85; 2 RCTs, 161 women; low-certainty evidence). We are uncertain whether NSAIDs reduce menstrual blood loss more than short-cycle progestogens (RR 0.80, 95% CI 0.49 to 1.32; 1 RCT 32 women; very low-certainty evidence). Antifibrinolytics Antifibrinolytics appear to be more effective in reducing heavy menstrual bleeding than placebo (MD -53 mL per cycle, 95% CI -63 to -44 mL per cycle; 4 RCTs, 565 women; moderate-certainty evidence). Antifibrinolytics may be similar to placebo on the incidence of side effects (RR 1.05, 95% CI 0.93 to 1.18; 1 RCT, 297 women; low-certainty evidence), and they are probably similar on the incidence of serious adverse events (thrombotic events; RR 0.10, 95% CI 0.00 to 2.46; 2 RCT, 468 women; moderate-certainty evidence). Antifibrinolytics may be more effective in reducing heavy menstrual bleeding than short-cycle progestogen (MD -111 mL per cycle, 95% CI -178 mL to -44 mL per cycle; 1 RCT, 46 women; low-certainty evidence). We are uncertain whether antifibrinolytics are similar to short-cycle progestogens on quality of life (RR 1.67, 95% CI 0.76 to 3.64; 1 RCT, 44 women; very low-certainty evidence), patient satisfaction (RR 0.91, 95% CI 0.59 to 1.39; 1 RCT, 42 women; very low-certainty evidence), or side effects (RR 0.85, 95% CI 0.65 to 1.12; 3 RCTs, 211 women; very low-certainty evidence). We are uncertain whether antifibrinolytics are more effective in reducing heavy menstrual bleeding when compared with long-cycle progestogen (MD -9 points per cycle, 95% CI -30 to 12 points per cycle; 2 RCTs, 184 women; low-certainty evidence). Antifibrinolytics may increase self-reported improvement in menstrual bleeding when compared with long-cycle medroxyprogesterone acetate (RR 1.32, 95% CI 1.08 to 1.61; 1 RCT, 94 women; low-certainty evidence). Antifibrinolytics may be similar to long-cycle progestogens on quality of life (MD 5, 95% CI -2.49 to 12.49; 1 RCT, 90 women; low-certainty evidence). We are uncertain whether antifibrinolytics are similar to long-cycle progestogens on side effects (RR 0.58, 95% CI 0.33 to 1.00; 2 RCTs, 184 women; very low-certainty evidence). There were no trials comparing antifibrinolytics to combined hormonal contraceptives. Combined hormonal contraceptives Combined hormonal contraceptives appear to be more effective for heavy menstrual bleeding than placebo or no treatment (RR 13.25, 95% CI 2.94 to 59.64; 2 RCTs, 363 women; moderate-certainty evidence). Combined hormonal contraceptives are probably similar to placebo on the incidence of side effects (RR 1.53, 95% CI 0.90 to 2.60; 2 RCTs, 411 women; moderate-certainty evidence). Progestogens There were no trials comparing progestogens to placebo. Limitations in the evidence included risk of bias in the primary RCTs, inconsistency between the primary RCTs, and imprecision in effect estimates. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that antifibrinolytics and combined hormonal contraceptives reduce heavy menstrual bleeding compared with placebo. There is low-certainty evidence that NSAIDs reduce heavy menstrual bleeding compared with placebo. There is low-certainty evidence that antifibrinolytics are more effective in reducing heavy menstrual bleeding when compared with NSAIDs and short-cycle progestogens, but we are unable to draw conclusions about the effects of antifibrinolytics compared to long-cycle progestogens, on low-certainty evidence.
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Affiliation(s)
| | - Anne Lethaby
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James Mn Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK
- Institute for Women's Health, University College London, London, UK
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Tran AP, Al Naber J, Tambor ES, Myers ER. Addressing heterogenous outcomes in uterine fibroid research: a call to action. Am J Obstet Gynecol 2020; 223:75.e1-75.e5. [PMID: 32199924 DOI: 10.1016/j.ajog.2020.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 01/20/2023]
Abstract
Uterine fibroid tumors are the most common benign pelvic tumors in women, with complications that include heavy menstrual bleeding, pelvic pain, reproductive complications, and bulk-related symptoms. Although the majority of uterine fibroid tumors are asymptomatic, those women who experience symptoms can experience substantial burdens on quality of life and daily functioning. Comparative effectiveness reviews of available medical, surgical, and radiologic treatments have found that a lack of high-quality data to inform treatment decisions is, in part, due to the use of heterogeneous outcomes and instruments in clinical studies. With multiple new interventions emerging, this call-to-action encourages the development and use of a core outcome set that will capture the most relevant, patient-important outcomes in late-phase and after-marketing therapeutic trials for uterine fibroid tumors. The core outcome set should be developed by a diverse, multistakeholder group comprised of key healthcare decision-makers. Development and uptake of a core outcome set ensures that a consistent, collaboratively vetted set of outcomes will be accessible across different studies and promotes transparency for innovators who seek to anticipate the evidence needs of patients, providers, payers, regulators, and other stakeholders.
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Affiliation(s)
- Annie P Tran
- Center for Medical Technology Policy, Baltimore, MD
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Chodankar R, Critchley HOD. Biomarkers in abnormal uterine bleeding†. Biol Reprod 2019; 101:1155-1166. [PMID: 30388215 PMCID: PMC6931000 DOI: 10.1093/biolre/ioy231] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022] Open
Abstract
Abnormal uterine bleeding (AUB) is an extremely common problem and represents a clinical area of unmet need. It has clinical implications and a high cost for the healthcare system. The PALM-COEIN acronym proposed by FIGO may be used as a foundation of care; it improves the understanding of the causes of AUB, and in doing so facilitates effective history taking, examination, investigations, and management. Heavy menstrual bleeding, a subset of AUB, is a subjective diagnosis and should be managed in the context of improving the woman's quality of life. Available evidence suggests that there is poor satisfaction with standard treatment options often resulting in women opting for major surgery such as hysterectomy. Such women would benefit from a tailored approach, both for diagnosis and treatment, highlighting the deficiency of biomarkers in this area. This article focuses on the causes of AUB as per the PALM-COEIN acronym, the researched biomarkers in this area, and the potential pathogenetic mechanisms. In the future, these approaches may improve our understanding of AUB, thereby enabling us to direct women to most suitable current treatments and tailor investigative and treatment strategies to ensure best outcomes, in keeping with the principles of personalized or precision medicine.
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Affiliation(s)
- Rohan Chodankar
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Hilary O D Critchley
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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