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Female Pelvic Medicine & Reconstructive... Feb 2021The aims of the study were to characterize pelvic floor and urinary symptoms in women seeking treatment for uterine fibroids and to explore the association between...
OBJECTIVE
The aims of the study were to characterize pelvic floor and urinary symptoms in women seeking treatment for uterine fibroids and to explore the association between uterine/fibroid size and pelvic floor symptoms.
METHODS
Women seeking treatment for uterine fibroids at a single academic center were enrolled in this cross-sectional study. All participants underwent pelvic imaging and completed the Symptom Severity Subscale of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) and the Pelvic Floor Distress Inventory (PFDI-20).
RESULTS
One hundred ninety-five women with a mean age of 41 ± 6 years and body mass index of 29 ± 7 kg/m2 were included. In this cohort, 58% identified as Black and 38% had at least 1 vaginal delivery. Women attributed pelvic pain (68%), dyspareunia (37%), and urinary incontinence (31%) to their fibroids. The mean ± SD UFS-QOL score was 48.7 ± 25.4, and 63% of participants reported being at least "somewhat bothered" by tightness/pressure in pelvic area, 60% by frequent daytime urination, and 47% by nocturia. The mean PFDI-20 score was 45.5 ± 31.9. Women reported being at least "somewhat bothered" by heaviness/dullness in the pelvis (60%), frequent urination (56%), pelvic pain or discomfort (48%), and sensation of incomplete bladder emptying (43%). The PFDI-20 and UFS-QOL scores were not correlated with uterine volume (r = 0.12, P = 0.12, and r = 0.06, P = 0.44) or fibroid size (r = 0.09, P = 0.26, and r = 0.01, P = 0.92).
CONCLUSIONS
Women presenting for evaluation and treatment of fibroids report high rates of pelvic floor symptoms, particularly urinary frequency and pelvic pressure. However, uterine size and fibroid size are not associated with pelvic floor symptom bother.
Topics: Adult; Cross-Sectional Studies; Dyspareunia; Female; Humans; Leiomyoma; Menorrhagia; Pelvic Pain; Quality of Life; Urinary Incontinence; Uterine Neoplasms
PubMed: 33105342
DOI: 10.1097/SPV.0000000000000967 -
Thrombosis Research Sep 2019The recent approval of direct-acting oral anticoagulants (DOAC) for long-term anticoagulation in atrial fibrillation and venous thromboembolism resulted in a rapid... (Review)
Review
The recent approval of direct-acting oral anticoagulants (DOAC) for long-term anticoagulation in atrial fibrillation and venous thromboembolism resulted in a rapid implementation of these new drugs into daily care. Although DOAC dosing is similar for women and men and, overall, results in comparable outcomes, sex specific issues need to be considered. This review will discuss DOAC topics specifically related to women's health, including the risks and benefits of DOAC treatment for women, the issue of abnormal uterine bleeding from DOAC and the risk and management of DOAC exposure in pregnancy.
Topics: Administration, Oral; Anticoagulants; Female; Humans; Menorrhagia; Pregnancy; Uterine Hemorrhage
PubMed: 31477222
DOI: 10.1016/S0049-3848(19)30361-5 -
Ugeskrift For Laeger Nov 2020Menorrhagia is a common complication to oral anticoagulant therapy in premenopausal women. Clinical management of menorrhagia poses a clinical dilemma with the need of... (Review)
Review
Menorrhagia is a common complication to oral anticoagulant therapy in premenopausal women. Clinical management of menorrhagia poses a clinical dilemma with the need of weighting bleeding risk against the risk of recurrent thrombosis. In this review, we describe the risk of menorrhagia during oral anticoagulant therapy, with emphasis on the differences between the specific anticoagulant drugs. We critically assess the treatment options for anticoagulant-associated menorrhagia, and we provide a treatment algorithm for the management of anticoagulant-associated menorrhagia.
Topics: Anticoagulants; Female; Humans; Menorrhagia; Thrombophlebitis
PubMed: 33280643
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Jun 2022Leiomyomas (fibroids) are common, usually benign, monoclonal tumors that arise from the uterine myometrium. Clinical presentation is variable; some patients are... (Review)
Review
Leiomyomas (fibroids) are common, usually benign, monoclonal tumors that arise from the uterine myometrium. Clinical presentation is variable; some patients are asymptomatic, whereas others experience heavy menstrual bleeding, pain, bulk symptoms, and/or alterations in fertility. Previously, treatment options for fibroids were largely surgical. However, over the last decade, options have grown to include many medical and procedural options that allow for uterine and fertility preservation. Clinicians must become familiar with these options to adequately counsel patients desiring treatment of fibroids.
Topics: Female; Fertility Preservation; Humans; Leiomyoma; Menorrhagia; Uterine Neoplasms; Uterus
PubMed: 35636810
DOI: 10.1016/j.ogc.2022.03.001 -
Obstetrics and Gynecology Sep 2023The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD)...
OBJECTIVE
The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making.
METHODS
APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding.
RESULTS
Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19-0.23%] at 1 year and 0.61% [95% CI 0.56-0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80-9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0-3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47-6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66-3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs.
CONCLUSION
Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion.
FUNDING SOURCE
Bayer AG.
CLINICAL TRIAL REGISTRATION
EU PAS register, EUPAS33461.
Topics: Female; Humans; Intrauterine Device Expulsion; Intrauterine Devices; Intrauterine Devices, Copper; Levonorgestrel; Menorrhagia; Retrospective Studies; Uterine Perforation; Middle Aged
PubMed: 37535968
DOI: 10.1097/AOG.0000000000005299 -
Obstetrics and Gynecology Dec 2022To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors. (Clinical Trial)
Clinical Trial
OBJECTIVE
To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors.
METHODS
The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) study was a U.S. cohort study using electronic health records from three integrated health care systems (Kaiser Permanente Northern California, Southern California, and Washington) and a health care information exchange (Regenstrief Institute). These analyses included individuals aged 50 years or younger with IUD insertions from 2001 to 2018. Intrauterine device expulsion cumulative incidence and incidence rates were estimated. Using Cox regression models, hazard ratios with 95% CIs were estimated before and after adjustment for risk factors of interest (age, race and ethnicity, parity, body mass index [BMI], heavy menstrual bleeding, and dysmenorrhea) and potential confounders.
RESULTS
In total, 228,834 individuals with IUD insertion and no delivery in the previous 52 weeks were identified (184,733 [80.7%] with levonorgestrel-releasing intrauterine system). Diagnosis of heavy menstrual bleeding-particularly a diagnosis in both recent and past periods-was the strongest risk factor for IUD expulsion. Categories with the highest risk of IUD expulsion within each risk factor included individuals diagnosed with overweight, obesity, and morbid obesity; those in younger age groups, especially among those aged 24 years or younger; and in those with parity of four or more. Non-Hispanic White individuals had the lowest incidence and risk, and after adjustment, Asian or Pacific Islander individuals had the highest risk. Dysmenorrhea was not independently associated with expulsion risk when adjusting for heavy menstrual bleeding.
CONCLUSION
Most risk factors for expulsion identified in this study appear consistent with known physiologic factors that affect uterine anatomy and physiology (age, BMI, heavy menstrual bleeding, parity). The increased risk of IUD expulsion among individuals of color warrants further investigation. Intrauterine devices are an effective long-term contraceptive; expulsion is uncommon, but patients should be counseled accordingly.
FUNDING SOURCE
Bayer AG.
CLINICAL TRIAL REGISTRATION
EU PAS register, EUPAS33461.
Topics: Female; Humans; Pregnancy; Cohort Studies; Demography; Dysmenorrhea; Intrauterine Device Expulsion; Intrauterine Devices; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Levonorgestrel; Menorrhagia; Risk Factors
PubMed: 36357958
DOI: 10.1097/AOG.0000000000005000 -
Journal of Thrombosis and Haemostasis :... Jul 2023Easy bruising is included as a major or minor criterion for the classification of multiple types of Ehlers-Danlos syndrome (EDS). Despite a longstanding recognition of...
BACKGROUND
Easy bruising is included as a major or minor criterion for the classification of multiple types of Ehlers-Danlos syndrome (EDS). Despite a longstanding recognition of the association between EDS and bleeding, we still lack a definitive understanding of the frequency, severity, and types of bleeding complications in patients with EDS.
OBJECTIVES
To evaluate hemorrhagic symptoms using the International Society of Thrombosis and Haemostasis bleeding assessment tool (ISTH-BAT) in a cohort of patients with defined types of EDS.
METHODS
We utilized the ISTH-BAT to characterize hemorrhagic symptoms and their severity in a cohort of 52 patients with classical, classical-like, hypermobile, or vascular EDS and a matched group of 52 healthy control subjects.
RESULTS
The mean ISTH-BAT score was 0.1 for healthy subjects and 9.1 for patients with EDS (p < .0001). An abnormal ISTH-BAT score was observed in 32 of 52 (62%) patients with EDS and 0 of 52 healthy controls (p < .0001). The most frequent bleeding symptoms were bruising, muscle hematomas, menorrhagia, epistaxis, bleeding from the oral cavity, and bleeding after tooth extraction. Menorrhagia that was life-threatening or required surgery was reported in 7 of 52 (14%) patients with EDS.
CONCLUSION
Patients with multiple types of EDS exhibit a wide range of bleeding symptoms ranging from mild to life-threatening episodes.
Topics: Female; Humans; Menorrhagia; Hemorrhagic Disorders; Hemostasis; Ehlers-Danlos Syndrome; Epistaxis
PubMed: 37179130
DOI: 10.1016/j.jtha.2023.04.004 -
Hamostaseologie Oct 2022Von Willebrand disease (VWD) is the most common inherited bleeding disorder, which results from a deficiency or dysfunction of von Willebrand factor (VWF). The major...
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, which results from a deficiency or dysfunction of von Willebrand factor (VWF). The major symptoms of patients affected by VWD include mucocutaneous and gastrointestinal bleeding, easy bruising, and prolonged provoked bleeding due to injury or surgery. Although women and men are equally likely to be affected by VWD, women continue to be disproportionately affected by the bleeding challenges. Women with VWD suffer from sex-specific symptoms, such as menorrhagia, and are at higher risk of reproductive problems and recurrent miscarriage. Furthermore, pregnant women with VWD are more likely at higher risk of suffering from primary and secondary peripartal hemorrhage and anemia and the need for transfusions. Despite being affected by gynecologic and obstetrical bleeding, women face multiple barriers in obtaining an accurate diagnosis. This constitutes a problem that needs to be addressed, and early appropriate medical care should be ensured. There are several effective treatment options for women with VWD that can significantly improve their quality of life, including desmopressin, VWF concentrates, hormonal therapy, and antifibrinolytic therapy. During pregnancy, the monitoring of VWF activity levels is essential. The peripartal management depends on the type of VWD and on the measured levels of VWF levels and activity prior to delivery.
Topics: Male; Female; Humans; Pregnancy; von Willebrand Diseases; von Willebrand Factor; Quality of Life; Hemorrhage; Menorrhagia
PubMed: 36323280
DOI: 10.1055/a-1891-9976 -
Seminars in Reproductive Medicine May 2020There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence... (Review)
Review
There is no approved medical therapy for adenomyosis and limited evidence to guide treatments in part due to the complexity of nonhistologic diagnosis and the prevalence of concomitant gynecologic conditions. Most available evidence focuses on the treatment of heavy menstrual bleeding, painful menses, and pelvic pain. Data evaluating fertility outcomes, sexual function, and quality of life following treatment are lacking. Additionally, there is no disease-specific measure of quality of life for adenomyosis. The levonorgestrel-releasing intrauterine system appears to be the most effective first-line therapy based on efficacy compared with oral agents, maintenance of steady-state hormonal levels, and contraceptive benefit. In areas where it is marketed, the progestin dienogest appears superior to combined oral contraceptives. Long-acting gonadotropin-releasing hormone agonists are effective and should be considered second-line therapy but are limited by hypogonadal effects. Additional data regarding oral gonadotropin-releasing hormone antagonists are required. While aromatase inhibitors demonstrate improvement in heavy menstrual bleeding and pelvic pain, further research is needed to determine their role in the management of adenomyosis. Progesterone receptor modulators may have a role for this disease if released again to market with appropriate safety parameters. Finally, modulation of prolactin and/or oxytocin may provide novel nonsteroidal treatment options.
Topics: Adenomyosis; Dysmenorrhea; Female; Hormone Antagonists; Humans; Levonorgestrel; Menorrhagia; Nandrolone; Pain Measurement; Quality of Life
PubMed: 33124017
DOI: 10.1055/s-0040-1719016 -
Clinical Obstetrics and Gynecology Dec 2020Perimenopause often represents a physiologically challenging phase in women's lives. The clinical presentation of the perimenopause includes infertility, irregular...
Perimenopause often represents a physiologically challenging phase in women's lives. The clinical presentation of the perimenopause includes infertility, irregular menstrual cycles, menorrhagia, and new onset of or worsening of mood disorders. Unlike menopause, which is characterized by low levels of estradiol and progesterone, the hallmark of perimenopause is highly variable levels of estradiol and progesterone with abrupt increases and decreases that are often described as a hormonal roller coaster. This chapter invites general gynecologists to understand the hormonal basis of the common complaints of perimenopause and offers information about the physiology of these issues and helpful treatment options.
Topics: Estradiol; Female; Follicle Stimulating Hormone; Gynecology; Humans; Menopause; Perimenopause
PubMed: 33044248
DOI: 10.1097/GRF.0000000000000578