Obfite krwawienie miesiączkowe
Rokowania, prognozy i postęp choroby

Obfite krwawienie miesiączkowe (HMB) dotyka 27-54% kobiet miesiączkujących i definiowane jest przez FIGO jako krwawienie przekraczające 95. percentyl w populacji. Rokowanie zależy od etiologii, skuteczności leczenia oraz wpływu na jakość życia. Nieleczone HMB może prowadzić do niedokrwistości z niedoboru żelaza, ciężkich krwawień wymagających hospitalizacji, rozrostu i raka endometrium (1-2% ryzyka przy anowulacyjnym krwawieniu), a także niepłodności, szczególnie u pacjentek z PCOS, otyłością, nadciśnieniem i cukrzycą insulinooporną. W leczeniu najwyższą skuteczność po 3 miesiącach wykazują LNG-IUS (87,5%) i ablacja endometrium (81,6%), natomiast skuteczność danazolu, progestagenów, doustnych antykoncepcyjnych i kwasu traneksamowego wynosi odpowiednio 65,8%, 63,6%, 63,4% i 48,2%. Współistnienie adenomiozy znacząco zwiększa ryzyko niepowodzenia ablacji (AOR=50,83, 95% CI 3,64–706,75). W populacji onkologicznej rokowanie komplikuje wpływ nowotworów i terapii na układ krzepnięcia oraz podwyższone ryzyko VTE, co wymaga indywidualizacji leczenia i monitorowania działań niepożądanych, zwłaszcza przy stosowaniu estrogenów.

  1. Prognostyka obfitego krwawienia miesiączkowego
    1. Naturalne rokowanie i ryzyko powikłań
    2. Skuteczność metod leczenia a prognostyka
    3. Czynniki predykcyjne niepowodzenia ablacji endometrium
    4. Szczególne uwarunkowania prognostyczne u pacjentek onkologicznych
    5. Pomiar skuteczności leczenia a prognoza długoterminowa
    6. Ograniczenia w ocenie skuteczności leczenia i rokowania
    7. Przyszłość prognostyki i leczenia HBM
    8. Podsumowanie czynników prognostycznych
    9. Kolejne rozdziały

Prognostyka obfitego krwawienia miesiączkowego

Obfite krwawienie miesiączkowe (Heavy Menstrual Bleeding, HMB) stanowi jeden z najczęściej występujących problemów ginekologicznych, dotykający od 27% do 54% miesiączkujących kobiet. 12 Międzynarodowa Federacja Ginekologii i Położnictwa (FIGO) zdefiniowała to schorzenie jako krwawienie przekraczające 95. percentyl w normalnej populacji, odchodząc od wcześniej stosowanych terminów jak „menorrhagia” czy „dysfunkcyjne krwawienie maciczne”. 3 Rokowanie w przypadku obfitego krwawienia miesiączkowego zależy od wielu czynników, w tym od etiologii, skuteczności zastosowanego leczenia oraz wpływu schorzenia na jakość życia pacjentki.

Naturalne rokowanie i ryzyko powikłań

Pojedyncze epizody krwawienia anovulacyjnego zazwyczaj mają dobre rokowanie. Jednakże nawracające epizody obfitego krwawienia miesiączkowego mogą prowadzić do znaczących konsekwencji zdrowotnych. 4 Do głównych powikłań nieprawidłowo leczonego obfitego krwawienia miesiączkowego należą:

  • Niedokrwistość z niedoboru żelaza – częste i obfite krwawienia maciczne zwiększają ryzyko jej wystąpienia 5
  • Ciężkie krwawienie – w niektórych przypadkach intensywność krwawienia może wymagać hospitalizacji w celu wyrównania gospodarki płynowej, przetoczenia krwi lub dożylnej terapii hormonalnej 6
  • Rozrost endometrium i rak endometrium – przewlekła niezrównoważona stymulacja estrogenowa błony śluzowej macicy zwiększa ryzyko rozwoju tych stanów (około 1-2% pacjentek z nieprawidłowo leczonym krwawieniem anovulacyjnym) 7
  • Niepłodność – często obserwowana u pacjentek z przewlekłą anovulacją, z nadmiernym wytwarzaniem androgenów lub bez 8

Szczególnie narażone na niepomyślne rokowanie są pacjentki z zespołem policystycznych jajników, otyłością, przewlekłym nadciśnieniem tętniczym oraz cukrzycą insulinooporną. 9 Nieleczone obfite krwawienie może znacząco zakłócać codzienne funkcjonowanie i wpływać na ogólny dobrostan pacjentek. 10

Skuteczność metod leczenia a prognostyka

Prognoza dla pacjentek z obfitym krwawieniem miesiączkowym jest ściśle związana z wyborem i skutecznością zastosowanej metody leczenia. Na podstawie dostępnych danych, skuteczność różnych opcji terapeutycznych po 3 miesiącach leczenia przedstawia się następująco (w kolejności malejącej, według mediany odsetka pacjentek osiągających miesięczną utratę krwi ≤ 80 ml): 11

  • System wewnątrzmaciczny uwalniający lewonorgestrel (LNG-IUS) – 87,5% skuteczności 12
  • Ablacja endometrium – 81,6% skuteczności 13
  • Danazol – 65,8% skuteczności 14
  • Progestageny (podawane przez około 3 tygodnie z 4 podczas cyklu miesiączkowego) – 63,6% skuteczności 15
  • Doustne tabletki antykoncepcyjne (COCs) – 63,4% skuteczności 16
  • Kwas traneksamowy (TXA) – 48,2% skuteczności 17

Warto zauważyć, że przedziały ufności dla tych estymacji wahają się od 16 punktów procentowych dla LNG-IUS do aż 94 punktów procentowych dla ablacji, co wskazuje na znaczną niepewność wielu szacunków. 1819

Czynniki predykcyjne niepowodzenia ablacji endometrium

W przypadku pacjentek poddawanych histeroskopowej ablacji endometrium, zidentyfikowano kilka czynników przedoperacyjnych związanych z wyższym ryzykiem niepowodzenia terapii: 20

  • Adenomioza – istotnie zwiększa ryzyko niepowodzenia (skorygowany iloraz szans AOR = 50,83, 95% CI, 3,64–706,75, p = 0,003) 21
  • Deficyt płynów podczas zabiegu (AOR = 1,003, 95% CI, 1,000–1,006, p = 0,044) 22
  • Współwystępowanie adenomiozy i bolesnego miesiączkowania 23
  • Śródoperacyjna utrata krwi (p = 0,047) 24

Ogólny wskaźnik niepowodzenia ablacji endometrium wynosi około 24,2%, co oznacza, że prawie jedna czwarta pacjentek wymaga dodatkowych procedur w celu złagodzenia objawów. 25

Szczególne uwarunkowania prognostyczne u pacjentek onkologicznych

Nastolatki i kobiety poddawane leczeniu onkologicznemu stanowią grupę szczególnego ryzyka nieprawidłowych krwawień miesiączkowych. Rokowanie w tej populacji jest uwarunkowane dodatkowymi czynnikami: 26

W tej grupie pacjentek zarówno wybór metody hamowania miesiączkowania, jak i postępowanie w przypadku ostrego krwawienia powinny być ściśle dostosowane do indywidualnej sytuacji pacjentki, rozpoznania onkologicznego, planu leczenia i potrzeb antykoncepcyjnych. 30 Decyzja o zastosowaniu estrogenów u pacjentek onkologicznych powinna uwzględniać indywidualny bilans korzyści i ryzyka oraz wiązać się z ścisłym monitorowaniem pod kątem znanych działań niepożądanych, takich jak toksyczność wątrobowa i żylna choroba zakrzepowo-zatorowa. 31

Pomiar skuteczności leczenia a prognoza długoterminowa

Dokładny pomiar stopnia utraty krwi miesiączkowej ma kluczowe znaczenie dla oceny odpowiedzi na leczenie i prognozy długoterminowej. 32 Chociaż subiektywna ocena nasilenia krwawienia ma ograniczoną dokładność, pozostaje istotna ze względu na subiektywny charakter HMB. 33 Badanie kohortowe z obserwacją kobiet ze zgłaszanym obfitym krwawieniem miesiączkowym, ale obiektywnie rejestrowaną normalną utratą krwi, wykazało, że po 3 latach tylko 26% kobiet było zadowolonych ze swoich miesiączek. 34

Problemy związane z obfitym krwawieniem miesiączkowym zależą nie tylko od obiektywnej intensywności krwawienia, ale również od stopnia, w jakim ta utrata krwi wpływa na jakość życia kobiety i jej ogólne samopoczucie. 35 Istnieje wiele metod ilościowego określania utraty krwi miesiączkowej:

  • Technika alkalicznej hematyny – pozostaje najdokładniejszą metodą, choć rzadko stosowaną poza środowiskiem badawczym 3637
  • Obrazkowa karta oceny utraty krwi (PBAC) – półilościowa metoda wykorzystująca wizualny system punktacji przedstawiający stopniowaną serię zabrudzonych tamponów i/lub podpasek 38

PBAC stał się najbardziej rozpowszechnioną metodą w badaniach klinicznych do potwierdzenia HMB i pomiaru odpowiedzi na leczenie, jednak obecny brak standaryzacji uniemożliwia jego szerokie zastosowanie w podstawowej opiece zdrowotnej. 39

Ograniczenia w ocenie skuteczności leczenia i rokowania

Systematyczny przegląd wykazał, że istnieje duża zmienność w raportowaniu wyników w badaniach dotyczących HMB, co utrudnia porównanie i łączenie rezultatów różnych badań. 40 Problem dotyczy nie tylko różnic w stosowanych punktach końcowych, ale także w definicjach, narzędziach oceny i czasokresach raportowania wyników. 41

Ta różnorodność ogranicza możliwość wykorzystania wszystkich dostępnych dowodów dotyczących skuteczności poszczególnych metod leczenia. W konsekwencji część danych nie jest wykorzystywana, a czas i pieniądze przeznaczone na prowadzenie badań pierwotnych są marnowane, ponieważ nie mogą one przyczynić się do oceny skuteczności leczenia. 42

Istnieje pilna potrzeba opracowania podstawowego zestawu wyników (Core Outcome Set, COS) dla badań dotyczących HMB, który zmniejszyłby tę zmienność, umożliwiając pełniejsze połączenie i porównanie wyników badań oraz zapobiegając stronniczości raportowania. 43

Przyszłość prognostyki i leczenia HBM

Obfite krwawienie miesiączkowe dotyka jedną na cztery kobiety w wieku rozrodczym, prowadząc do znacznego pogorszenia jakości ich życia. 44 Istnieje kilka opcji leczenia, jednak nadal brakuje jednoznacznych dowodów dotyczących skuteczności, bezpieczeństwa i kosztów dostępnych terapii. 45

Wraz z wprowadzaniem nowych metod leczenia, utrzymującymi się niepewnościami i lukami w istniejących dowodach, istnieje potrzeba jasnej, kompleksowej i zwięzłej syntezy dowodów, uwzględniającej również poglądy i preferencje kobiet z HMB. 46

Badania porównujące różne opcje terapeutyczne w zależności od podgrup populacji są kluczowe dla optymalizacji leczenia. 47 Identyfikacja ścieżki inicjowania i eskalacji leczenia opartej na dowodach naukowych jest niezbędna do zminimalizowania przewlekłego niekorzystnego wpływu HMB na zdrowie i optymalizacji dostępu pacjentek do pożądanych terapii w odpowiednim czasie. 48

Podsumowanie czynników prognostycznych

Rokowanie w obfitym krwawieniu miesiączkowym zależy od wielu czynników, które można podsumować następująco:

  • Skuteczność zastosowanego leczenia – LNG-IUS i ablacja endometrium wykazują najwyższą skuteczność (powyżej 80%) 4950
  • Etiologia krwawienia – przyczyny strukturalne (np. adenomioza) mogą być trudniejsze do leczenia 51
  • Współistniejące schorzenia – szczególnie zespół policystycznych jajników, otyłość, nadciśnienie tętnicze i cukrzyca insulinooporna 52
  • Subiektywna ocena pacjentki – wpływ krwawienia na jakość życia 53
  • Odpowiedź na wstępne leczenie – prognoza jest lepsza przy dobrej odpowiedzi na początkowe interwencje 54
  • Dostępność zaawansowanych opcji terapeutycznych – wpływa na długoterminowe rokowanie w przypadku niepowodzenia pierwszej linii leczenia 55

Z właściwym leczeniem i wsparciem ze strony personelu medycznego, obfite krwawienie miesiączkowe może być skutecznie kontrolowane, zapobiegając komplikacjom takim jak anemia i poprawa jakości życia pacjentek. 56

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  1. 13.04.2026
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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. […] 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 (e.g., AUB-P is used if the AUB is caused by endometrial polyps, AUB-L if it is caused by leiomyoma, among others) FIGO defines AUB as bleeding that is abnormally heavy and/or abnormal in timing and heavy menstrual bleeding (HMB) as bleeding above the 95th percentile of the normal population. […] 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.
  • #2 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding
    Heavy menstrual bleeding is common, affecting anywhere from 27% to 54% of people who menstruate. […] 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.
  • #3 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. […] 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 (e.g., AUB-P is used if the AUB is caused by endometrial polyps, AUB-L if it is caused by leiomyoma, among others) FIGO defines AUB as bleeding that is abnormally heavy and/or abnormal in timing and heavy menstrual bleeding (HMB) as bleeding above the 95th percentile of the normal population. […] 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.
  • #4 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.
  • #5 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.
  • #6 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.
  • #7 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.
  • #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 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.
  • #10 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding
    Heavy menstrual bleeding is common, affecting anywhere from 27% to 54% of people who menstruate. […] 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.
  • #11 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.
  • #12 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.
  • #13 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.
  • #14 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.
  • #15 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.
  • #16 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.
  • #17 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.
  • #18 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.
  • #19 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. […] More evidence is needed, particularly for the classes of oral treatments.
  • #20 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #21 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #22 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #23 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #24 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #25 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #26 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    Adolescents undergoing cancer treatment are at high risk of abnormal menstrual bleeding as a direct result of hematologic malignancies or as a secondary effect of chemotherapy, radiation therapy, or pretreatment regimens for stem cell or bone marrow transplantation. […] Therapy for both menstrual suppression and management of acute bleeding episodes should be tailored to the patient, the cancer diagnosis and treatment plan, and the individuals contraceptive needs. […] Medical management is the initial approach for patients who are experiencing an episode of acute heavy bleeding. […] Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management.
  • #27 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    Adolescents undergoing cancer treatment are at high risk of abnormal menstrual bleeding as a direct result of hematologic malignancies or as a secondary effect of chemotherapy, radiation therapy, or pretreatment regimens for stem cell or bone marrow transplantation. […] Therapy for both menstrual suppression and management of acute bleeding episodes should be tailored to the patient, the cancer diagnosis and treatment plan, and the individuals contraceptive needs. […] Medical management is the initial approach for patients who are experiencing an episode of acute heavy bleeding. […] Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management.
  • #28 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    Adolescents undergoing cancer treatment are at high risk of abnormal menstrual bleeding as a direct result of hematologic malignancies or as a secondary effect of chemotherapy, radiation therapy, or pretreatment regimens for stem cell or bone marrow transplantation. […] Therapy for both menstrual suppression and management of acute bleeding episodes should be tailored to the patient, the cancer diagnosis and treatment plan, and the individuals contraceptive needs. […] Medical management is the initial approach for patients who are experiencing an episode of acute heavy bleeding. […] Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management.
  • #29 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    The risk of VTE in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. […] Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. […] The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the riskbenefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.
  • #30 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    Adolescents undergoing cancer treatment are at high risk of abnormal menstrual bleeding as a direct result of hematologic malignancies or as a secondary effect of chemotherapy, radiation therapy, or pretreatment regimens for stem cell or bone marrow transplantation. […] Therapy for both menstrual suppression and management of acute bleeding episodes should be tailored to the patient, the cancer diagnosis and treatment plan, and the individuals contraceptive needs. […] Medical management is the initial approach for patients who are experiencing an episode of acute heavy bleeding. […] Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management.
  • #31 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    The risk of VTE in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. […] Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. […] The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the riskbenefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.
  • #32 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. […] 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 (e.g., AUB-P is used if the AUB is caused by endometrial polyps, AUB-L if it is caused by leiomyoma, among others) FIGO defines AUB as bleeding that is abnormally heavy and/or abnormal in timing and heavy menstrual bleeding (HMB) as bleeding above the 95th percentile of the normal population. […] 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.
  • #33 Outcome Measures for Heavy Menstrual Bleeding
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/
    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 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. […] There are numerous methods of quantifying menstrual blood loss, of which the alkaline hematin remains the most accurate method, however, is rarely used outside of a research setting.
  • #34 Outcome Measures for Heavy Menstrual Bleeding
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/
    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 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. […] There are numerous methods of quantifying menstrual blood loss, of which the alkaline hematin remains the most accurate method, however, is rarely used outside of a research setting.
  • #35 Outcome Measures for Heavy Menstrual Bleeding
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/
    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 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. […] There are numerous methods of quantifying menstrual blood loss, of which the alkaline hematin remains the most accurate method, however, is rarely used outside of a research setting.
  • #36 Outcome Measures for Heavy Menstrual Bleeding
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/
    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 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. […] There are numerous methods of quantifying menstrual blood loss, of which the alkaline hematin remains the most accurate method, however, is rarely used outside of a research setting.
  • #37 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.
  • #38 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.
  • #39 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.
  • #40 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 systematic review has demonstrated that there is wide variation in the outcomes used in studies of HMB, however, by in depth review, it has also established that definitions, assessment tools and time-points for reporting outcomes are extremely varied. […] 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.
  • #41 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 systematic review has demonstrated that there is wide variation in the outcomes used in studies of HMB, however, by in depth review, it has also established that definitions, assessment tools and time-points for reporting outcomes are extremely varied. […] 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.
  • #42 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 systematic review has demonstrated that there is wide variation in the outcomes used in studies of HMB, however, by in depth review, it has also established that definitions, assessment tools and time-points for reporting outcomes are extremely varied. […] 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.
  • #43 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 systematic review has demonstrated that there is wide variation in the outcomes used in studies of HMB, however, by in depth review, it has also established that definitions, assessment tools and time-points for reporting outcomes are extremely varied. […] 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.
  • #44 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. […] With newly introduced treatments, persistent uncertainties and gaps in the existing evidence, there is a need for a clear, comprehensive and succinct evidence synthesis to address this uncertainty while taking into consideration the views and treatment preferences of women with HMB. […] 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.
  • #45 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. […] With newly introduced treatments, persistent uncertainties and gaps in the existing evidence, there is a need for a clear, comprehensive and succinct evidence synthesis to address this uncertainty while taking into consideration the views and treatment preferences of women with HMB. […] 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.
  • #46 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. […] With newly introduced treatments, persistent uncertainties and gaps in the existing evidence, there is a need for a clear, comprehensive and succinct evidence synthesis to address this uncertainty while taking into consideration the views and treatment preferences of women with HMB. […] 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.
  • #47 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
    The project will include various subgroup and sensitivity analyses to explore the varied effectiveness of available treatment options across population subgroups of interest. […] 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. […] 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.
  • #48 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
    The project will include various subgroup and sensitivity analyses to explore the varied effectiveness of available treatment options across population subgroups of interest. […] 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. […] 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.
  • #49 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.
  • #50 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. […] More evidence is needed, particularly for the classes of oral treatments.
  • #51 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 overall failure rate of 24.2% was observed in the study, with significant associations found between ablation failure and fluid deficit (p = 0.002) and intra-operative blood loss (p = 0.047). […] There was a statistically significant moderate association between adenomyosis (p = 0.003, φ = 0.37) and failed endometrial ablation. […] Logistic regression revealed that 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. […] The significant predictors for endometrial ablation failure were adenomyosis and fluid deficit.
  • #52 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.
  • #53 Outcome Measures for Heavy Menstrual Bleeding
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5779559/
    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 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. […] There are numerous methods of quantifying menstrual blood loss, of which the alkaline hematin remains the most accurate method, however, is rarely used outside of a research setting.
  • #54 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/01/options-for-prevention-and-management-of-menstrual-bleeding-in-adolescent-patients-undergoing-cancer-treatment
    Adolescents undergoing cancer treatment are at high risk of abnormal menstrual bleeding as a direct result of hematologic malignancies or as a secondary effect of chemotherapy, radiation therapy, or pretreatment regimens for stem cell or bone marrow transplantation. […] Therapy for both menstrual suppression and management of acute bleeding episodes should be tailored to the patient, the cancer diagnosis and treatment plan, and the individuals contraceptive needs. […] Medical management is the initial approach for patients who are experiencing an episode of acute heavy bleeding. […] Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management.
  • #55 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
    The project will include various subgroup and sensitivity analyses to explore the varied effectiveness of available treatment options across population subgroups of interest. […] 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. […] 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.
  • #56 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding
    Heavy menstrual bleeding is common, affecting anywhere from 27% to 54% of people who menstruate. […] 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.

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nowotwór hematologiczny adenomioza niedokrwistość z niedoboru żelaza cukrzyca insulinooporna rozrost endometrium ablacja endometrium system wewnątrzmaciczny uwalniający lewonorgestrel zespół policystycznych jajników przeszczep szpiku kostnego żylna choroba zakrzepowo-zatorowa rak endometrium nadciśnienie tętnicze menorrhagia danazol bolesne miesiączkowanie toksyczność wątrobowa progestagen obfite krwawienie miesiączkowe obrazkowa karta oceny utraty krwi podstawowy zestaw wyników układ krzepnięcia kwas traneksamowy przeszczep komórek macierzystych dysfunkcyjne krwawienie maciczne