Curative effect of motherwort combined with ethinylestradiol-cyproterone acetate on dysfunctional uterine bleeding

OBJECTIVE

This study aimed to investigate the curative effect of motherwort combined with ethinylestradiol-cyproterone acetate (EE/CPA) on dysfunctional uterine bleeding (DUB).

METHODS

Atotal of 68 patients with DUB were divided into a single medication group (treated with EE/CPA) and a combination medication group(treated with motherwort and EE/CPA). The clinical efficacy, uterine hemodynamic parameters, sex hormone levels, coagulation index levels, blood routine test levels, and adverse reactions of patients were evaluated.

RESULTS

After three months of treatment, total treatment response rate of the combination medication group was significantly higher than that of the single medication group. Decreased uterine volume, endometrial thickness and resistance index (RI), increased pulsatility index(PI), average flow rate, and uterine artery blood flow, as well asreduced follicle-stimulating hormone (FSH), luteinizing hormone (LH),estradiol (E2), progesterone (P), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen (FIB), thrombin time(TT), platelet count (PLT), red blood cell (RBC), and hemoglobin (Hb)levels were witnessed in patients of the two groups. In thecombination medication group, there exhibited reduced uterine volume, endometrial thickness and RI, elevated PI, average flow rate, and uterine artery blood flow, reduced P, E2, FSH, LH, aPTT, PT, FIB, TT,PLT, RBC, and Hb levels in comparison to the single medication group.

CONCLUSION

The combination of motherwort and EE/CPA is clinically effective in the treatment of DUB.

Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness

INTRODUCTION

Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data.

RESULTS

This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis.

CONCLUSION

AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.

A Study of Patients Undergoing Abdominal Hysterectomy in Tertiary Care Institute

Background Hysterectomy is one of the most common surgical procedures performed.Patient education, compliance, and socioeconomic status are important determinants in choosing the mode of treatment; however, medical treatment is usually inadequate.Thus, in the present study, we tried to study the various profiles of patients undergoing abdominal hysterectomies reported in tertiary care centers. Materials and Methods  Brief clinical data were noted from the case records, which include age, parity, presenting symptoms, past surgical and medical history, hemoglobin status, preoperative dilatation and curettage, and indications of hysterectomy. Results Most hysterectomies were performed on women between the ages of 41 and 45, with the average parity being 3.2 and the majority of cases having three children. Abnormal vaginal bleeding associated with various forms of menstrual irregularities was the most common complaint for which patients sought advice, and the incidence of patients undergoing tubal ligation was the most common previous surgery procedure, with anemia being the most common preoperative-associated condition. The fibroid was the most common demonstration in the current study, which brought forth abdominal hysterectomy for the chosen participants. Conclusion Findings from the current study suggest abdominal hysterectomy to be the most preferred route of surgery commonly in the women of age group 40 to 45 years or higher, precisely due to the occurrence of a higher parity rate in this age category. Fibroid uterus, dysfunctional uterine bleeding, and the presence of other menstrual complaints were the most probable indications for abdominal hysterectomy demonstrated by the individuals in the present study. Moreover, anemia was the most predominant complication associated pre-operatively, followed by other clinical manifestations such as hypertension, diabetes mellitus, and urinary tract infection.

Effect of systematic nursing on patients with dysfunctional uterine bleeding and rehabilitation

Purpose: To study the effect of systematic nursing on patients with dysfunctional uterine bleeding and rehabilitation. Methods: 98 patients who were treated in our hospital for dysfunctional uterine bleeding from May 2017 to May 2019 were selected, and were divided into a control group (n=49, conventional nursing) and an observation group (n=49, systematic nursing) according to the random number table method. The curative effect, uterine bleeding time, normalization time of biochemical index recovery, psychologic status, quality of life, and nursing satisfaction of the two groups were compared. Results: The efficacy rate of the observation group (93.88%) was higher than the control group (77.55%); the observation group had less uterine bleeding time and activated partial thromboplastin time (APTT) in comparison with the control group (P<0.05). There was no significant difference in self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores between the two groups before intervention (P>0.05); after intervention, the SAS and SDS scores of both groups decreased, with the observation group being more significant (P<0.05. The quality of life score and nursing satisfaction rate of the observation group were higher (P<0.05). Conclusion: Systematic nursing can improve the curative effect of patients with dysfunctional uterine bleeding, accelerate the rehabilitation process, relieve negative emotions, and improve the quality of life and nursing satisfaction.

Abnormal Uterine Bleeding

Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormal uterine bleeding, both acute and chronic. Didactically, the treatment options were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and the latter is based mainly on hormonal therapy, anti-inflammatory drugs and antifibrinolytics.

Sonographic Evaluation for Endometrial Polyps: The Interrupted Mucosa Sign

OBJECTIVES

To evaluate the interrupted mucosa sign for identification of endometrial polyps, using pathologic confirmation as the reference standard, compared to other accepted sonographic findings.

METHODS

We reviewed 195 patients referred for pelvic sonographic evaluations for suspected endometrial polyps in this retrospective Institutional Review Board-approved study. Of these, 82 had tissue sampling of the endometrium and constituted the final study group. Patient data, including age, menopausal status, last menstrual period, and final pathologic diagnosis, were recorded. Sonograms were reviewed by 2 blinded board-certified radiologists for endometrial features, including thickness, echogenicity, vascularity, presence of a mass, and the interrupted mucosa sign. Descriptive statistics and multivariate logistic regression analysis were performed.

RESULTS

The mean age of the patients was 44.99 (SD, 9.88) years, 79.1% of whom were premenopausal. Pathologic diagnosis confirmed polyps in 58 (70.73%). A single feeding vessel was visualized in 36 patients with polyps (62.07%), whereas the interrupted mucosa sign was visualized in 34 (58.62%). The presence of a feeding vessel, the interrupted mucosa sign, or both detected 48 (82.76%) of the polyps. In the multivariate analysis, only the interrupted mucosa sign was a statistically significant predictor of pathologic diagnosis of a polyp (P= .035), with an odds ratio of 3.83 (95% confidence interval, 1.10-13.29). Other sonographic findings were not independent predictors of a polyp: mass (P = .35), single feeding vessel (P = .31), endometrial thickness (P = .88), and endometrial echogenicity (P = .45). The sensitivity, specificity, and positive predictive value of the interrupted mucosa sign were 59%, 75%, and 85%, respectively.

CONCLUSIONS

The interrupted mucosa sign is a promising sonographic sign for identification of endometrial polyps, with greater predictive power than previously described signs. It has the potential to improve the diagnostic performance of sonography, especially when used in combination with other described signs.

[Patient with pemphigus vulgaris complicated with dysfunctional uterine bleeding upon glucocorticoid usage: a case report]

Pemphigus is a severe chronic autoimmune mucocutaneous bullous disease. Glucocorticoids are considered as the first line of treatment for this disease. Dysfunctional uterine bleeding is also observed as a result of hypothalamic-pituitary-ovary axis dysfunction. This study reported one female patient with pemphigus vulgaris complicated with dysfunctional uterine bleeding upon systemic glucocorticoid usage. Before this disease was diagnosed, the patient experienced normal menstruation. The mechanism of dysfunctional uterine bleeding triggered by glucocorticoids is elucidated on the basis of case studies and literature review.

Satisfaction and health-related quality of life in women with heavy menstrual bleeding; results from a non-interventional trial of the levonorgestrel-releasing intrauterine system or conventional medical therapy

Purpose

To evaluate the patient satisfaction and health related quality of life (HRQoL) for levonorgestrel-releasing intrauterine system (LNG-IUS) versus conventional medical treatments ([CMTs] combined oral contraceptives, oral progestins, and antifibrinolytics, alone or in combination) in Asian women with heavy menstrual bleeding (HMB).

Patients and methods

A total of 647 patients diagnosed with HMB were recruited to this non-interventional study from the eight participating countries in Asia. Patient satisfaction was recorded at the last visit (at 12 months or premature discontinuation). At each visit (at 3, 6, and 12 months), patients completed the menorrhagia multi-attribute scale (MMAS) to assess HRQoL.

Results

A total of 83.5% of patients on the LNG-IUS were “very satisfied” or at least “satisfied” with the therapeutic effect of HMB treatment, compared with 59.2% of patients with CMTs (P<0.05). The mean (± standard deviation) MMAS score increased from 41.4±24.5 to 87.7±21.4 in the LNG-IUS arm, and from 44.1±24.9 to 73.1±25.3 in the CMTs arm. This increase was significantly higher in patients on the LNG-IUS, as compared with those on CMTs (P<0.05). The improvement in HRQoL in both treatment groups correlated with the body mass index of the patient, with larger improvement obtained in women with a higher body mass index.

Conclusion

The majority of women using the LNG-IUS or CMTs for HMB were satisfied with their treatment, and both treatment modalities were associated with significant improvements in HRQoL over time. The improvement was greater with the LNG-IUS, compared with CMTs.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding (DUB) is defined as abnormal uterine bleeding that results from an ovarian endocrinopathy. It may be associated with ovulatory and anovulatory cycles. The diagnosis of DUB depends on a thorough history and physical examination to exclude organic disorders. In older women, endometrial biopsy should be done before starting therapy. The treatment depends on an understanding of the menstrual cycle. In less urgent cases, anovulatory cycles are managed using progesterone replacement, and ovulatory cycles respond well to non-steroidal anti-inflammatory drugs (NSAIDs). In urgent cases oral or intravenous estrogen is used, and emergency dilation and currettage are done if the hemorrhage fails to stop.