Materiały źródłowe

• #1 Outcome Measures for Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/

  Heavy menstrual bleeding is one of the most commonly encountered gynecological problems. […] Heavy menstrual loss is one of the most commonly encountered gynecological problems, and is scientifically defined as greater than 80 ml of blood loss each period, however, this is rarely measured in clinical practice. […] The previously used terms, menorrhagia and dysfunctional uterine bleeding have been rejected by the International Federation of Gynecology and Obstetrics (FIGO), who have developed the FIGO Classification of Causes of Abnormal Uterine Bleeding and use the term abnormal uterine bleeding (AUB) with a suffix to represent the cause. […] When the NICE published their guidance for the treatment of HMB in 2007 they recommended that HMB be defined as excessive menstrual blood loss that interferes with the woman’s physical, emotional, social and material quality of life.

• #2 Abnormal (Dysfunctional) Uterine Bleeding: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/257007-overview

  Single episodes of anovulatory bleeding generally carry a good prognosis. […] Patients who experience repetitive episodes might experience significant consequences. Frequent uterine bleeding will increase the risk for iron deficiency anemia. Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy. Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma. Timely and appropriate management will prevent most of these problems. […] About 1-2% of women with improperly managed anovulatory bleeding eventually might develop endometrial cancer. Infertility associated with chronic anovulation, with or without excess androgen production, is frequently seen in these patients. Patients with polycystic ovarian syndrome, obesity, chronic hypertension, and insulin-resistant diabetes mellitus particularly are at risk.

• #3 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  With proper workup, diagnosis, treatment, and follow-up care, prognosis is favorable, though largely depends on the etiology. Menorrhagia can significantly impact a persons quality of life, ability to perform daily activities, productivity, and relationships. […] Patients who lose more than 80 mL of blood, especially repetitively, are at risk for serious medical sequelae. These women are likely to develop iron-deficiency anemia because of their blood loss. Menorrhagia is the most common cause of anemia in premenopausal women. This usually can be remedied by oral ingestion of ferrous sulfate to replace iron stores as well as management of the abnormal bleeding. If the bleeding is severe enough to cause volume depletion, patients may experience shortness of breath, fatigue, palpitations, and other related symptoms. In the most serious of scenarios, anemia can lead to congestive heart failure and death. This level of anemia necessitates hospitalization for intravenous fluids, possible transfusion and prompt medical and/or surgical management.

• #4 Use of mixed-treatment-comparison methods in estimating efficacy of treatments for heavy menstrual bleeding | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-18-17

  LNG-IUS and endometrial ablation are very efficacious in treating HMB. […] The study yielded useful insights on using MTC in sparse evidence networks. […] The Bayesian credible intervals reflected the various sources of uncertainty. […] Based on available data, estimates after 3 months of treatment indicate the following descending order of efficacy (posterior median): LNG-IUS and endometrial ablation with comparably high response rates (87.5% and 81.6% of women achieving MBL 80 mL, respectively), followed by danazol (65.8%), progestogens given for close to 3 weeks out of 4 during the menstrual cycle (63.6%), COCs (63.4%), and TXA (48.2%). […] The widths of the 95% credible intervals range from 16 percentage points for LNG-IUS to 94 percentage points for ablation. […] Thus, most estimates had substantial uncertainty.

• #5 Use of mixed-treatment-comparison methods in estimating efficacy of treatments for heavy menstrual bleeding | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-18-17

  The analysis produced posterior median estimates of % MBL 80 mL that plausibly reflect the current evidence: a high level of efficacy for LNG-IUS and endometrial ablation and somewhat lower efficacy for oral treatments. […] The findings of these systematic reviews of direct comparisons add support to the indication from our analysis that ablation is an effective treatment for HMB. […] These systematic reviews therefore agree with the estimates from our MTC that LNG-IUS and ablation are the most effective of the treatments studied at reducing MBL, that progestogens given for less than 2 weeks out of 4 during the menstrual cycle are least effective, and that danazol, progestogens given for close to 3 weeks out of 4, and tranexamic acid also showed efficacy. […] The synthesis of the evidence in an MTC framework yielded plausible estimates of % MBL 80 mL at 3 months for the eight treatment classes. LNG-IUS and endometrial ablation had the highest efficacy, but the 95% credible interval for ablation was very wide.

• #6 Clinical Predictive Factors of Failure of Hysteroscopic Endometrial Ablation: Retrospective Cohort Study at a Tertiary University Hospital

  https://www.imrpress.com/journal/CEOG/50/1/10.31083/j.ceog5001003/htm

  Among pre-operative factors, adenomyosis, fluid deficit and combined adenomyosis and dysmenorrhea were found to predict failure of hysteroscopic endometrial ablation. […] The failure rate was 24.2%. […] There was a statistically significant association between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] However, the age, body mass index (BMI), parity, number of miscarriages, number of cesarean sections, uterine length, endometrial thickness and procedure duration had no significant association with endometrial ablation. […] There was no significant relationship between the uterine abnormalities in general and the outcome of the endometrial ablation (p = 0.637). […] However, patients with combined adenomyosis and dysmenorrhea had a statistically significant association with outcome of the endometrial ablation (p = 0.016, φ = 0.28) and were more likely to have a failed endometrial ablation (crude odds ratio (COR) = 4.67, 95% confidence interval (CI), 1.35–16.09).

• #7 Clinical Predictive Factors of Failure of Hysteroscopic Endometrial Ablation: Retrospective Cohort Study at a Tertiary University Hospital

  https://www.imrpress.com/journal/CEOG/50/1/10.31083/j.ceog5001003/htm

  Logistic regression to adjust for related factors revealed that the adenomyosis (adjusted odds ratio (AOR) = 50.83, 95% CI, 3.64–706.75, p = 0.003) and fluid deficit (AOR = 1.003, 95% CI, 1.000–1.006, p = 0.044) had a higher likelihood of an unsuccessful outcome. […] Overall, 24.2% had a failed endometrial ablation and had to undergo an additional procedure to alleviate the symptoms.

• #8 Abnormal (Dysfunctional) Uterine Bleeding: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/257007-overview

  Single episodes of anovulatory bleeding generally carry a good prognosis. […] Patients who experience repetitive episodes might experience significant consequences. Frequent uterine bleeding will increase the risk for iron deficiency anemia. Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy. Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma. Timely and appropriate management will prevent most of these problems. […] About 1-2% of women with improperly managed anovulatory bleeding eventually might develop endometrial cancer. Infertility associated with chronic anovulation, with or without excess androgen production, is frequently seen in these patients. Patients with polycystic ovarian syndrome, obesity, chronic hypertension, and insulin-resistant diabetes mellitus particularly are at risk.

• #9 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  With proper workup, diagnosis, treatment, and follow-up care, prognosis is favorable, though largely depends on the etiology. Menorrhagia can significantly impact a persons quality of life, ability to perform daily activities, productivity, and relationships. […] Patients who lose more than 80 mL of blood, especially repetitively, are at risk for serious medical sequelae. These women are likely to develop iron-deficiency anemia because of their blood loss. Menorrhagia is the most common cause of anemia in premenopausal women. This usually can be remedied by oral ingestion of ferrous sulfate to replace iron stores as well as management of the abnormal bleeding. If the bleeding is severe enough to cause volume depletion, patients may experience shortness of breath, fatigue, palpitations, and other related symptoms. In the most serious of scenarios, anemia can lead to congestive heart failure and death. This level of anemia necessitates hospitalization for intravenous fluids, possible transfusion and prompt medical and/or surgical management.

• #10 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Complications of heavy menstrual bleeding depend on the underlying etiology, but can include anemia, infertility, endometrial cancer, and associated complications of medical and/or surgical management. When severe, bleeding can lead to hypotension and even shock if not promptly evaluated and treated.

• #11 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Complications of heavy menstrual bleeding depend on the underlying etiology, but can include anemia, infertility, endometrial cancer, and associated complications of medical and/or surgical management. When severe, bleeding can lead to hypotension and even shock if not promptly evaluated and treated.

• #12 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  Heavy menstrual bleeding can be serious if you lose so much blood that you show signs of anemia. Anemia can be life-threatening without treatment. […] Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you dont get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

• #13 Abnormal (Dysfunctional) Uterine Bleeding: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/257007-overview

  Single episodes of anovulatory bleeding generally carry a good prognosis. […] Patients who experience repetitive episodes might experience significant consequences. Frequent uterine bleeding will increase the risk for iron deficiency anemia. Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy. Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma. Timely and appropriate management will prevent most of these problems. […] About 1-2% of women with improperly managed anovulatory bleeding eventually might develop endometrial cancer. Infertility associated with chronic anovulation, with or without excess androgen production, is frequently seen in these patients. Patients with polycystic ovarian syndrome, obesity, chronic hypertension, and insulin-resistant diabetes mellitus particularly are at risk.

• #14 Abnormal (Dysfunctional) Uterine Bleeding: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/257007-overview

  Single episodes of anovulatory bleeding generally carry a good prognosis. […] Patients who experience repetitive episodes might experience significant consequences. Frequent uterine bleeding will increase the risk for iron deficiency anemia. Flow can be copious enough to require hospitalization for fluid management, transfusion, or intravenous hormone therapy. Chronic unopposed estrogenic stimulation of the endometrial lining increases the risk of both endometrial hyperplasia and endometrial carcinoma. Timely and appropriate management will prevent most of these problems. […] About 1-2% of women with improperly managed anovulatory bleeding eventually might develop endometrial cancer. Infertility associated with chronic anovulation, with or without excess androgen production, is frequently seen in these patients. Patients with polycystic ovarian syndrome, obesity, chronic hypertension, and insulin-resistant diabetes mellitus particularly are at risk.

• #15 Outcome Measures for Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/

  The problems associated with heavy menstrual loss depend not just on the objective heaviness of the bleeding, but the degree to which this blood loss impacts on the woman’s quality of life and general wellbeing. […] Assessment of the subjective quality of life issues experienced should inform management of women with HMB.

• #16 Treatment options for women with heavy menstrual bleeding: a protocol for comprehensive systematic review, network meta-analyses and health economic assessment | BMJ Open

  https://bmjopen.bmj.com/content/15/4/e085292.full

  Heavy menstrual bleeding (HMB) affects one in four women of reproductive age, leading to significant impairment of their quality of life. […] Several treatment options are offered for heavy menstrual bleeding; however, there is limited evidence on the effectiveness, safety and cost of available treatments. […] Our aim is to perform a comprehensive and up-to-date evidence synthesis on the clinical and cost-effectiveness of all available treatment options for women with HMB and better inform care provision for affected women overall and within specific population subgroups. […] The planned analysis will offer the most comprehensive evidence synthesis and health economic evaluation of all available treatment options for the management of heavy periods. […] The project will incorporate a discrete choice experiment to quantify womens preferences for different treatments for heavy periods and will be incorporated into the planned health economic evaluation.

• #17 Outcome Measures for Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/

  However, accurately measuring the degree of blood loss remains important as it provides a valuable tool for the measurement of response to treatment, and in research, where the validity of results depends on the accuracy of blood loss measurement. […] Although subjective reporting of heavy menstrual bleeding has been shown to be limited in its accuracy, it remains important due to the subjective nature of HMB. […] A cohort follow-up study of women with reported heavy menstrual loss, but objectively recorded normal blood loss found that by 3 years only 26% were quoted as being happy with their periods. […] The authors of this study concluded that while some women are content with being reassured that their periods are normal, a significant number will intent on some form of medical or surgical treatment.

• #18 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  Heavy menstrual bleeding can be serious if you lose so much blood that you show signs of anemia. Anemia can be life-threatening without treatment. […] Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you dont get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

• #19 Outcome Measures for Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/

  However, accurately measuring the degree of blood loss remains important as it provides a valuable tool for the measurement of response to treatment, and in research, where the validity of results depends on the accuracy of blood loss measurement. […] Although subjective reporting of heavy menstrual bleeding has been shown to be limited in its accuracy, it remains important due to the subjective nature of HMB. […] A cohort follow-up study of women with reported heavy menstrual loss, but objectively recorded normal blood loss found that by 3 years only 26% were quoted as being happy with their periods. […] The authors of this study concluded that while some women are content with being reassured that their periods are normal, a significant number will intent on some form of medical or surgical treatment.

• #20 Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-0887-y

  Heavy menstrual bleeding (HMB) is a common gynecological condition that adversely affects quality of life and work productivity. Approximately 10-35% of women report heavy menstrual periods at some stage during their reproductive years, with 5% consulting a medical practitioner for investigation of HMB. In research, HMB is defined as a measured menstrual blood loss (MBL) of 80mL per cycle, but studies have repeatedly shown that at least 40% of women seeking medical attention for heavy periods lose less than this volume. In clinical practice, the decision to treat is usually based on a woman’s self-reported symptoms and the effect of these symptoms on quality of life rather than any objective measurement, which concurs with current guidelines for management of HMB. However, self-perception of menstrual loss is unreliable.

• #21 Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-0887-y

  Many clinical trial protocols require treatment efficacy for HMB to be determined by quantitative changes in MBL before a license can be granted for a new drug or surgical procedure. The perceived gold-standard method to measure MBL is the alkaline hematin (AH) technique, which was established in 1964, with later modifications. It is an expensive procedure that requires specialized laboratory facilities. Patients must collect, store and then submit all their used feminine products for MBL analysis, which may not be acceptable or feasible for many women. Therefore, it is mainly confined to clinical trials and the research setting to confirm or refute HMB and to evaluate efficacy of medical or surgical treatments. […] An alternative semiquantitative method uses a pictorial blood loss assessment chart (PBAC) to assess MBL. This simple, inexpensive tool comprises a visual scoring system that depicts a graded series of soiled tampons and/or towels. The patient can directly record the number of her used feminine items and the degree to which they are bloodstained. Since its inception in 1990, the PBAC has become increasingly accepted by regulatory bodies as a substitute for the AH technique and is now the most widely used method in clinical studies to confirm HMB and to measure response to treatment. […] PBACs are best suited to the controlled and specific environment of clinical studies, where clinical outcome parameters are defined. The current lack of standardization precludes widespread use of the PBAC in primary care.

• #22 Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10350948/

  Heavy menstrual bleeding (HMB) detrimentally effects women. It is important to be able to compare treatments and synthesise data to understand which interventions are most beneficial, however, when there is variation in outcome reporting, this is difficult. […] A core outcome set (COS) would reduce the evident variation in reporting of outcomes in studies of HMB, allowing more complete combination and comparison of study results and preventing reporting bias. […] This in-depth review of past research into heavy menstrual bleeding shows that there is the need for a core outcome set for heavy menstrual bleeding. […] We found a wide variation in outcome reporting for studies of interventions for HMB as might well be expected for a condition that can be managed in multiple ways and can be caused by several underlying pathologies. This variation occurred across types of outcomes as well as how and when they were reported. Menstrual blood loss was the most reported primary and secondary outcome and was particularly favoured by studies which involved a medical intervention. In contrast, amenorrhoea was favoured as a primary outcome by surgical studies.

• #23 Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10350948/

  Heavy menstrual bleeding (HMB) detrimentally effects women. It is important to be able to compare treatments and synthesise data to understand which interventions are most beneficial, however, when there is variation in outcome reporting, this is difficult. […] A core outcome set (COS) would reduce the evident variation in reporting of outcomes in studies of HMB, allowing more complete combination and comparison of study results and preventing reporting bias. […] This in-depth review of past research into heavy menstrual bleeding shows that there is the need for a core outcome set for heavy menstrual bleeding. […] We found a wide variation in outcome reporting for studies of interventions for HMB as might well be expected for a condition that can be managed in multiple ways and can be caused by several underlying pathologies. This variation occurred across types of outcomes as well as how and when they were reported. Menstrual blood loss was the most reported primary and secondary outcome and was particularly favoured by studies which involved a medical intervention. In contrast, amenorrhoea was favoured as a primary outcome by surgical studies.

• #24 Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10350948/

  The evident variation in reporting of outcomes in studies of HMB means that combination and comparison of study results is limited to those reporting similar outcomes and thus prohibits use of all the available evidence for specific treatments. Consequently, some data will not be used, and the time and money spent conducting the primary research will have been wasted as it cannot contribute towards evaluation of the treatment. We have demonstrated that a core outcome set is needed for studies of HMB, and we have subsequently carried out qualitative work with patients and an international consensus process involving all stakeholders to develop one. This core outcome set will be disseminated via publication in the coming months, and we hope that it will improve research and clinical care in this important area of womens health.

• #25 Treatment options for women with heavy menstrual bleeding: a protocol for comprehensive systematic review, network meta-analyses and health economic assessment | BMJ Open

  https://bmjopen.bmj.com/content/15/4/e085292.full

  Identifying an evidence-based treatment initiation and escalation pathway is key to minimising the chronic adverse health impact of HMB and optimise patient access to desired treatments in a timely fashion. […] The main strength of our findings is the predicted high generalisability given the size of existing evidence and the potential to directly impact day-to-day patient care. […] The findings will help raise awareness of the available treatment options for HMB and reduce the stigma associated with seeking medical care for HMB.

• #26 Treatment options for women with heavy menstrual bleeding: a protocol for comprehensive systematic review, network meta-analyses and health economic assessment | BMJ Open

  https://bmjopen.bmj.com/content/15/4/e085292.full

  Identifying an evidence-based treatment initiation and escalation pathway is key to minimising the chronic adverse health impact of HMB and optimise patient access to desired treatments in a timely fashion. […] The main strength of our findings is the predicted high generalisability given the size of existing evidence and the potential to directly impact day-to-day patient care. […] The findings will help raise awareness of the available treatment options for HMB and reduce the stigma associated with seeking medical care for HMB.

• #27 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  With proper workup, diagnosis, treatment, and follow-up care, prognosis is favorable, though largely depends on the etiology. Menorrhagia can significantly impact a persons quality of life, ability to perform daily activities, productivity, and relationships. […] Patients who lose more than 80 mL of blood, especially repetitively, are at risk for serious medical sequelae. These women are likely to develop iron-deficiency anemia because of their blood loss. Menorrhagia is the most common cause of anemia in premenopausal women. This usually can be remedied by oral ingestion of ferrous sulfate to replace iron stores as well as management of the abnormal bleeding. If the bleeding is severe enough to cause volume depletion, patients may experience shortness of breath, fatigue, palpitations, and other related symptoms. In the most serious of scenarios, anemia can lead to congestive heart failure and death. This level of anemia necessitates hospitalization for intravenous fluids, possible transfusion and prompt medical and/or surgical management.

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