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Women's Health (London, England) Jan 2016Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at... (Review)
Review
Heavy menstrual bleeding (HMB) has significant adverse effects on the quality of life of many women, placing an economic burden on both health services and society at large. Thus, it is essential that all women with HMB have easy access to the proper diagnostic and therapeutic work-up in an outpatient fashion, avoiding the more time-consuming inpatient management. This new outpatient approach for HMB is one of the latest development of gynecological practice and can offer both diagnostic and therapeutic procedures. This manuscript aims to show the current possibilities of the modern management of HMB, which can be safely and effectively accomplished in the outpatient setting: global and directed endometrial biopsy, levonorgestrel intrauterine system insertion as well as minimally invasive surgical procedures (encompassing a variety of operative hysteroscopic procedures and second-generation endometrial ablation) are described below.
Topics: Antifibrinolytic Agents; Endometrial Ablation Techniques; Endometrium; Female; Humans; Intrauterine Devices, Medicated; Menorrhagia; Minimally Invasive Surgical Procedures; Outcome Assessment, Health Care; Women's Health
PubMed: 26696502
DOI: 10.2217/whe.15.80 -
JSLS : Journal of the Society of... 2015Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to...
BACKGROUND AND OBJECTIVES
Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.
METHODS
We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.
RESULTS
The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.
CONCLUSIONS
Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.
Topics: Adolescent; Adult; Dysmenorrhea; Endometriosis; Female; Follow-Up Studies; Humans; Laparoscopy; Menorrhagia; Pelvic Pain; Referral and Consultation; Retrospective Studies; Young Adult
PubMed: 26005317
DOI: 10.4293/JSLS.2015.00019 -
Taiwanese Journal of Obstetrics &... Oct 2015Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a "complaint of a large amount of bleeding during menstrual cycles that occurs over several... (Review)
Review
Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a "complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles" and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL). During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.
Topics: Antifibrinolytic Agents; Female; Hemostatic Techniques; Humans; Hysterectomy; Menorrhagia; Pregnancy; Severity of Illness Index; Treatment Outcome
PubMed: 26522096
DOI: 10.1016/j.tjog.2015.08.001 -
Best Practice & Research. Clinical... Apr 2017Patient-reported outcome measures (PROMs) have the potential to be extremely valuable in the clinical care delivery for women who report heavy menstrual bleeding (HMB).... (Review)
Review
Patient-reported outcome measures (PROMs) have the potential to be extremely valuable in the clinical care delivery for women who report heavy menstrual bleeding (HMB). Increasingly, studies on HMB have incorporated PROMs to evaluate the impact of bleeding on quality of life. These measures have included semiquantitative charts and pictograms, questionnaires to assess symptoms and impact on quality of life, and health-related quality of life questionnaires. Recent systematic reviews have highlighted inconsistency of outcome measurement across studies on HMB as a challenge limiting the interpretability of the body of literature and the ability to generate consensus on the relative effectiveness of treatment options. Consequently, research initiatives and international collaborations are working to harmonize outcome measurement. Harmonizing the use of questionnaires in research and clinical care has the potential to improve patient-centered care delivery for women with HMB and improve the generation of patient-focused evidence-based guidelines for the evaluation and treatment of HMB.
Topics: Female; Humans; Menorrhagia; Menstruation; Patient Reported Outcome Measures; Patient-Centered Care; Physician-Patient Relations; Practice Patterns, Physicians'; Quality of Life; Surveys and Questionnaires
PubMed: 27829537
DOI: 10.1016/j.bpobgyn.2016.09.009 -
Journal of Infection and Public Health May 2023COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the association between the COVID - 19 vaccine and menstrual irregularities. A meta-analysis was performed to estimate the pooled prevalence of a range of menstrual disorders that may occur in women following COVID - 19 vaccination.
METHODS
After searching for epidemiological studies, we systematically performed a meta-analysis on PubMed/Medline, EMBASE, and Science Direct. Sixteen studies were finally included in the study. We estimated the pooled prevalence and corresponding 95 % confidence intervals (CIs) for a group of menstrual disorders, including menorrhagia, polymenorrhea, abnormal cycle length, and oligomenorrhea. Heterogeneity was assessed using the I statistic and the Q test.
RESULTS
Overall, the pooled prevalence of menorrhagia was 24.24 % (pooled prevalence 24.24 %; 95 % CI: 12.8-35.6 %). The pooled prevalence of polymenorrhea was 16.2 % (pooled prevalence: 16.2 %; 95 % CI: 10.7-21.6 %). The pooled prevalence of abnormal cycle length was relatively lower than that of the other disorders (pooled prevalence: 6.6 %; 95 % CI: 5.0-8.2 %). The pooled prevalence of oligomenorrhea was 22.7 % (95 % CI: 13.5-32.0 %).
CONCLUSION
The findings indicate that menorrhagia, oligomenorrhea, and polymenorrhea were the most common menstrual irregularities after vaccination. The findings also suggest that a relatively high proportion of women suffer from menstrual irregularities. Further longitudinal studies are needed to confirm the causal relationship between COVID-19 vaccination and menstrual irregularities.
Topics: Female; Humans; COVID-19; COVID-19 Vaccines; Menorrhagia; Menstruation Disturbances; Oligomenorrhea; Vaccination
PubMed: 36934644
DOI: 10.1016/j.jiph.2023.02.019 -
Expert Review of Hematology Jun 2023Women and girls with bleeding disorders face multiple bleeding challenges throughout their life. The most significant morbidity and mortality are due to heavy menstrual... (Review)
Review
INTRODUCTION
Women and girls with bleeding disorders face multiple bleeding challenges throughout their life. The most significant morbidity and mortality are due to heavy menstrual bleeding and postpartum hemorrhage in their reproductive years. The ASH/ISTH/NHF/WFH 2021 guidelines on diagnosing and managing von Willebrand disease (VWD) provide several new updates.
AREAS COVERED
Women with VWD have a higher prevalence of heavy menstrual bleeding. The subpopulation of adolescents is particularly vulnerable, as the diagnosis is often delayed with increased comorbidity of iron deficiency anemia and associated symptoms. A detailed review is done on the prevalence of bleeding-related complications, especially heavy menstrual bleeding (HMB) and post-partum hemorrhage (PPH). The management strategies are also reviewed in detail, with a specific focus on the target factor levels and the use of antifibrinolytics.
EXPERT OPINION
The 2021 ASH/ISTH/NHF/WFH diagnostic and management recommendations are reviewed with a specific focus on hormonal methods of HMB management and antifibrinolytics in this situation. The reviewed topics include neuraxial anesthesia, factor cutoff, and tranexamic acid use in the postpartum period.
Topics: Pregnancy; Adolescent; Female; Humans; von Willebrand Diseases; Menorrhagia; Antifibrinolytic Agents; Postpartum Hemorrhage
PubMed: 36609196
DOI: 10.1080/17474086.2023.2166925 -
Current Opinion in Obstetrics &... Aug 2014Review of recent data from clinical trials and descriptions of endometrial morphology with administration of selective progesterone receptor modulators (SPRMs). (Review)
Review
PURPOSE OF REVIEW
Review of recent data from clinical trials and descriptions of endometrial morphology with administration of selective progesterone receptor modulators (SPRMs).
RECENT FINDINGS
Recent reports concerning administration of SPRMs, specifically the efficacy of ulipristal acetate in reducing fibroid size and rapid control of menstrual blood loss, have renewed clinical interest in this class of compound. Histological data from studies with SPRMs report that this class of drugs is associated with progesterone receptor modulator-associated endometrial changes. Data on mechanisms of action are lacking. The antagonistic progesterone effect of SPRMs has shown promising results in animal studies with endometriosis. Sex steroid receptor effects of PRMs outside the reproductive tract raise the potential for use in neurology and oncology, and although there are several randomized trials in these areas, there are limited small studies published to date.
SUMMARY
The SPRM ulipristal acetate is an effective treatment for preoperative treatment of fibroids and a reliable emergency contraceptive. This class of compounds holds the potential for long-term effective medical management of fibroids and may have utility in the management of other sex steroid-dependent conditions.
Topics: Breast Neoplasms; Contraceptives, Postcoital; Endometriosis; Female; Hormone Antagonists; Humans; Leiomyoma; Menorrhagia; Norpregnadienes; Quality of Life; Receptors, Progesterone; Uterine Neoplasms
PubMed: 24950125
DOI: 10.1097/GCO.0000000000000082 -
Pediatric Annals Apr 2020Heavy menstrual bleeding (HMB) is a common complaint among adolescent girls. It reflects an abnormal volume of blood loss during the menstrual cycle. Abnormal uterine... (Review)
Review
Heavy menstrual bleeding (HMB) is a common complaint among adolescent girls. It reflects an abnormal volume of blood loss during the menstrual cycle. Abnormal uterine bleeding can manifest as HMB but includes menstrual irregularity. In many cases, immaturity of the hypothalamic-pituitary-ovarian axis or hormonal conditions like polycystic ovarian syndrome leading to anovulatory cycles are the underlying cause for heavy menses. However, in girls with HMB, especially those not responding to the usual hormonal attempts to manage HMB, an underlying bleeding disorder should be considered. Up to 62% of adolescents with HMB have a bleeding disorder, many without anemia at presentation. Evaluation for HMB in an adolescent girl should include referrals to an adolescent medicine specialist or gynecologist and pediatric hematologist. [Pediatr Ann. 2020;49(4):e163-e169.].
Topics: Adolescent; Female; Humans; Medical History Taking; Menorrhagia; Physical Examination; Referral and Consultation
PubMed: 32275760
DOI: 10.3928/19382359-20200321-01 -
Current Opinion in Obstetrics &... Aug 2016The purpose of the review is to update the reader on endometrial ablation as a treatment for abnormal uterine bleeding, including modifications to initial treatment... (Review)
Review
PURPOSE OF REVIEW
The purpose of the review is to update the reader on endometrial ablation as a treatment for abnormal uterine bleeding, including modifications to initial treatment guidelines and current data on long-term outcomes.
RECENT FINDINGS
Endometrial ablation continues to be a successful treatment for abnormal uterine bleeding, with new indications potentially forthcoming. Patient selection is key, as certain patient groups are at increased risk for ablation failure and complications.
SUMMARY
Gynecologists should continue to offer this treatment to appropriate patients with abnormal uterine bleeding, with adequate counseling regarding anticipated success rates, factors associated with failure, alternative treatments, and long-term consequences related to ablation.
Topics: Directive Counseling; Endometrial Ablation Techniques; Endometrium; Female; Humans; Menorrhagia; Patient Selection; Postoperative Complications; Practice Guidelines as Topic; Treatment Outcome
PubMed: 27253237
DOI: 10.1097/GCO.0000000000000282 -
Seminars in Thrombosis and Hemostasis Apr 2017von Willebrand factor (VWF) is an adhesive plasma protein that primarily acts to bridge platelets to sites of vascular injury and thus prevent bleeding. von Willebrand... (Review)
Review
von Willebrand factor (VWF) is an adhesive plasma protein that primarily acts to bridge platelets to sites of vascular injury and thus prevent bleeding. von Willebrand disease (VWD) is the most common inherited bleeding disorder and is caused by deficiency and/or defects of VWF, leading to low levels of plasma VWF or dysfunctional VWF. Factor VIII (FVIII) is also reduced in many patients with VWD, since VWF stabilizes and protects FVIII from degradation. Treatment of VWD primarily entails replacement of VWF, and sometimes FVIII, to protect against bleeding. This may entail use of VWF/FVIII concentrates, and/or desmopressin (1-deamino-8-d-arginine vasopressin) to release endogenous VWF in some patients. Adjunct therapies include antifibrinolytics and hormonal therapies in women. Optimal treatment of VWD entails measuring the effects of treatment, either as a trial before surgery or during therapeutic management. This is usually accomplished by performance of the same tests that are used to help diagnose VWD, although additional monitoring (clinically and/or by laboratory testing) may also be performed. The current review provides an overview of the treatment of VWD but is primarily focused on the monitoring of such therapy.
Topics: Coagulants; Deamino Arginine Vasopressin; Drug Combinations; Drug Monitoring; Factor VIII; Female; Hemostatics; Humans; Menorrhagia; Treatment Outcome; von Willebrand Diseases; von Willebrand Factor
PubMed: 27472426
DOI: 10.1055/s-0036-1585080