Bleeding In Premenopausal Women Research Articles

Hysteroscopic Partial Endometrial Resection Versus Thermal Balloon Ablation for Treatment of Heavy Menstrual Bleeding in Premenopausal Women

Hysteroscopic Partial Endometrial Resection Versus Thermal Balloon Ablation for Treatment of Heavy Menstrual Bleeding in Premenopausal Women

Hysteroscopic diode laser myolysis: from a case series to literature review of incisionless myolysis techniques for managing heavy menstrual bleeding in premenopausal women.

This case series examined the safety and effectiveness of hysteroscopic myolysis using laser-induced interstitial thermo-therapy (LITT) for treating heavy menstrual bleeding (HMB) in premenopausal women with FIGO type 1 or 2 uterine fibroids, not planning for future fertility. Additionally, a comprehensive review of innovative, minimally invasive, incisionless myolysis techniques was conducted. Women with HMB, sonographically diagnosed with a single FIGO type 1 or 2 fibroid, underwent hysteroscopic myolysis using the Leonardo® diode laser. Effectiveness was assessed via transvaginal ultrasound measurement of myoma size, volume and vascularization pre and post-procedure. Moreover, we also evaluated any improvements in symptoms using the Pictorial Blood Loss Assessment Chart (PBAC score) scores. The procedure resulted in significant HMB reductions and noticeable fibroid size, volume, and vascularization decrease in all three patients, with no reported complications. The literature review revealed both advantages and limitations of the minimally invasive, incisionless myolysis techniques. Hysteroscopic laser myolysis is a safe and effective therapeutic intervention for patients experiencing HMB, diagnosed with FIGO type 1 or 2 fibroids, and not planning for future fertility. The procedure resulted in significant reductions in menstrual blood loss and fibroid size. Despite the promising results, it is essential to note the limitations of this report, including its case series design, a small number of patients, and a short follow-up period. Further research is necessary to confirm these results.

PREMENOPAUSAL PERIOD AND ABNORMAL UTERINE BLEEDING

The article describes the analysis of abnormal uterine bleeding in premenopausal women, studies the causes and methods of treatment. The study was conducted in the gynecological department of the 1st clinic of the Samarkand State Medical University for 2021-2022. The study used general medical, clinical laboratory and instrumental diagnostic methods. The study investigated the causes and treatments for abnormal uterine bleeding and recommendations for improving treatment methods are given.

Evaluation of a Standardized Questionnaire for Initial Assessment of Abnormal Uterine Bleeding in Premenopausal Women

ObjectiveTo assess the effect of a standardized questionnaire for premenopausal women with abnormal uterine bleeding (AUB) on clinical information collection and duration of consultation. MethodsWe conducted a before and after study involving 100 premenopausal women undergoing consultation for AUB. During stage 1, 50 consultations were recorded on a consultation sheet with no specific template. During stage 2, 50 women completed a 26-item auto-administered standardized questionnaire before the consultation, which was then reviewed with the consultant and added to the medical record. The duration of consultation was assessed in subgroups of 27 women in each stage. Two independent evaluators assessed the quality and completeness of data collected in the medical records using a score sheet developed by experts. Outcomes from both stages were compared using the t test. ResultsThe descriptive characteristics were similar in both groups. The mean global scores of the quality and completeness of data collected improved significantly between stages 1 and 2, from 67% ± 12% to 95% ± 5% (P < 0.0001), as did medical background scores (54% ± 29% vs. 85% ± 13%; P < 0.0001) and AUB-related symptoms scores (69% ± 13% vs. 97% ± 5%; P < 0.0001). A mean reduction in duration of consultation of nearly 4 minutes was observed (24.6 ± 4.3 min vs. 20.7 ± 4.8 min; P < 0.0001). ConclusionThe AUB-specific standardized questionnaire improves quality and completeness of data collected in medical records and reduces duration of consultation.

Role of Antimicrobials in management of Dysfunctional Uterine Bleeding in Premenopausal Women

Role of Antimicrobials in management of Dysfunctional Uterine Bleeding in Premenopausal Women

354 The role of 3D ultrasonography and histopathology in diagnosis of abnormal uterine bleeding in premenopausal women

Introduction: Abnormal uterine bleeding in premenopausal women is one of the most common presenting complaints in gynecology clinics. It is a complicated clinical problem with different causes. However, physicians with a solid knowledge of menstrual physiology and a through approach to differential diagnosis can evaluate and manage the problem with confidence. Aim of work: The aim of this work is to evaluate the role of 3D ultrasonography and endometrial sampling, in comparison to each other, in detection of endometrial pathologies in premenopausal women having abnormal uterine bleeding.

Body Mass Index as an Indicator for Endometrial Biopsy in Premenopausal Women with Heavy Menstrual Bleeding

Background: Although Obesity is a risk factor of endometrial hyperplasia/ carcinoma, there is no consensus on using the BMI as a predictor for endometrial biopsy screening in patients with heavy menstrual bleeding in pre-menopausal women. Therefore, it’s clinically important to identify BMI cutoff values as a predictor for endometrial hyperplasia/ carcinoma in premenopausal women with heavy menstrual bleeding.Aim of the Study: To determine the feasibility of using Body Mass Index (BMI) as an indicator to perform endometrial biopsy in premenopausal women presented with heavy menstrual bleeding.Patients &amp; Methods: This is a cross-sectional study that was conducted in Obstetrics and Gynecology Clinic /Al-Emamain Al-Kadhemein teaching medical city in Baghdad where women 150 women who are 40-50 years old with heavy menstrual bleeding where sent for endometrial biopsy. 100 women had abnormal endometrial biopsy results, histopathological results of the abnormal endometrial samples were classified into following groups: hyperplasia without atypia, hyperplasia with atypia, and hyperplasia with atypia and cancer. Statistical analysis conducted to correlate The Body Mass Index (BMI) with the status of endometrial biopsy.Results: 42% of the women with BMI≥30 kg/m2 have hyperplasia with atypia or carcinoma compared to 10% of women who BMI&lt;30 kg/m2 (p&lt;0.001). from 54 women who had hyperplasia with atypia in endometrial sample results; 77.7% of such patients were BMI≥30 kg/m2. Receiver operating characteristic analysis shows that using BMI ≥30 kg/m2 as a predictor of hyperplasia with atypia or carcinoma carries a sensitivity of 80.77 % and specify of 86.00% with area under the curve (AUC) value of 0.83 (CI. 0.75-0.92) and (p&lt;0.001). women with BMI≥30 kg/m2 has a relative risk (RR) of 3.98 of developing endometrial hyperplasia (without atypia or with atypia+carcinoma) and a relative risk (RR) of 4.11 of developing hyperplasia with atypia or carcinoma (p&lt;0.001).Conclusion: Our results indicate that BMI regardless of the age is the highest risk factor for abnormal endometrial hyperplasia premenopausal women. Also, BMI≥30 kg/m2 has highest risk for developing endometrial hyperplasia with atypia or carcinoma. BMI≥30 kg/m2 can be used as predictor of endometrial hyperplasia in premenopausal women with heavy uterine bleeding.

A CASE STUDY ON THE TRAINING OF PELVIC FLOOR MUSCLE FOLLOWING HYSTERECTOMY TO IMPROVE THE QUALITY OF LIFE

Now a day’s abnormal uterine bleeding in premenopausal women is the most common indication of hysterectomy which usually results from myomas and adenomyosis. In this case study, a 38-year-old female, with a complaint of abnormally heavy bleeding with menstrual cycle irregularity and discomfort for 15 days each month with dysmenorrhoea. She was diagnosed for large fibroid deposition at the posterior wall of the uterus and extroverted in the position. So, she was prescribed for vaginal Hysterectomy by a gynecologist further investigation, she underwent a vaginal hysterectomy, post-operatively patient was complaining about lower abdominal pain and difficulty in bed mobility activities. There was weakness in pelvic floor muscles after the surgery, due to which she had worried about overweight, physical health, and her quality of life. So she approached the physiotherapist, where she had trained for pelvic floor muscle training two-three sessions per day for two weeks with abdominal, back, and hip strengthening exercises with a home exercise program. VAS scale, Oxford grading system, PFIQ, QOL questionnaire was taken as outcome measure prior and after the intervention. The present case report emphasizes the effect of the combination of different exercises for pelvic floor muscles encasing the comprehensive rehabilitation plan including a home exercise regimen allowing the patient to recover early and return to daily activities.

An Immunohistochemical Study of Estrogen and Progesterone Receptors in Endometrium of Women with Dysfunctional Uterine Bleeding

Abnormal Uterine Bleeding (AUB) is a common complaint that affects large numbers of women from puberty to menopause. It negatively affects health and quality of life of women affected. AUB also has an economic impact for both women and society Abnormal uterine bleeding in premenopausal women is one of the most frequent problems in gynecological practice. Although some of the cases may be due to an organic cause, over 50% of the patients undergoing hysterectomy for menorrhagia have dysfunctional uterine bleeding (DUB). To analyze the percentage and intensity of estrogen receptors (ER) and progesterone receptors (PR) in endometrium of patients with DUB. This study suggests that estrogen and progesterone receptors have an important role in etiopathogenesis of dysfunctional uterine bleeding and alteration in the morphology of endometrium such as development of endometrial hyperplasia. Women in the reproductive age who are complaining of abnormal uterine bleeding, usually have an increase in ER alpha and PR expression in their endometrium.

2020 Hong Kong College of Obstetricians and Gynaecologists guideline on investigations of premenopausal women with abnormal uterine bleeding.

Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.

A clinical study on abnormal uterine bleeding in premenopausal women

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstrual cycle with excessive duration, frequency and amount of loss. AUB accounts about 70% in perimenopausal women in gynaecology OPD. Abnormal uterine bleeding is not a disease, it is a symptom. The aim of the study was to evaluate abnormal uterine bleeding in perimenopausal women and to study the various menstrual abnormalities and causes of AUB in perimenopausal women. Study design: This study was a hospital based cross sectional study which included 95 women in perimenopausal age group (40-51 years) with abnormal uterine bleeding. The history, clinical examination, USG and histopathological findings was collected. Clinical findings were classified by PALM-COEIN classification. All women underwent endometrial sampling to rule out endometrial pathology. Results: The mean age of the patients was 44.89(±2.93) years. Parity of more than 2 (46.3%) was most common. Menorrhagia (58.9%) was the most common bleeding pattern followed menometrorrhagia (23.2%). Leiomyomo 37 (38.9%) was the most common clinical finding followed by adenomyosis 29 (30.5%). Ultrasonographically fibroid uterus (37.8%) was the most common USG findings followed by Adenomyosis (30.5%). The most common endometrial thickness was 9-12mm (43.1%). Histopathological examination revealed secretory phase endometrium (35.8%) was the most common finding followed by proliferative endometrium (20%). Conclusion: Uterine fibroid was the leading cause of AUB. Clinical examination and ultrasound findings correlated well in the diagnosis of fibroids. Evaluation of the endometrium in perimenopausal women presenting with AUB is essential to rule out endometrial pathology.

Recurrence and prediction of abnormal uterine bleeding and re-intervention after initial hysteroscopic treatment: a retrospective cohort study.

To estimate the incidence of recurrence of complaints and repeated interventions after hysteroscopic treatment for abnormal uterine bleeding in premenopausal women and to determine potential predictors for re-intervention. This is a retrospective cohort study in two secondary care centers in the Netherlands. We included 313 premenopausal women who underwent hysteroscopy for complaints of abnormal uterine bleeding and who had intrauterine pathology visualized at ultrasound. The intrauterine structure was hysteroscopically removed. These women were compared with women who had a hysteroscopy for abnormal uterine bleeding, but in whom hysteroscopy showed no abnormalities. We used Chi-squared test for categorical variables and independent-samples T test for continuous variables. p Values less than 0.05 were considered to indicate statistical significance. In total, 262 women had intrauterine pathology removed at hysteroscopy; 136 (52%) women had recurrence of complaints, while 101 women (39%) underwent re-intervention. Heavy menstrual bleeding at baseline and multiparity were predictive factors for recurrence of abnormal uterine bleeding and re-intervention. In the 51 women with abnormal uterine bleeding in whom hysteroscopy showed no intrauterine abnormality, 29 women (60%) had recurrence of complaints and 12 (24%) a re-intervention. In premenopausal women with abnormal uterine bleeding, treatment of intrauterine pathology often does not reduce the complaints, thus questioning the effectiveness of hysteroscopic removal of these structures.

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.

Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.

No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women.

Abnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem. To provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age. Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB. Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition. Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions. Published literature was retrieved through searches of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary (e. g., uterine hemorrhage, menorrhagia) and key words (e. g., menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1999 to March 2011. Searches were updated on a regular basis and incorporated in the guideline to February 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology- related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table1). Implementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding, their families, and society. The economic cost of implementing these guidelines in the Canadian health care system was not considered. RECOMMENDATIONS.

Endometrial Biopsy: American College of Nurse-Midwives.

Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.

Anticoagulation for venous thromboembolism (VTE) and rates of per vaginal bleeding in pre-menopausal women

Anticoagulation for venous thromboembolism (VTE) and rates of per vaginal bleeding in pre-menopausal women

Surgical management of heavy menstrual bleeding: part 2

Key content Heavy menstrual bleeding affects one in five premenopausal women and can significantly impair quality of life. Management options for heavy menstrual bleeding are diverse and include a variety of medical, radiological and surgical treatments. Surgical treatment options are endometrial ablation, hysterectomy and myomectomy. Treatment choice for heavy menstrual bleeding should take into account underlying pathology, and the woman's preferences and fertility needs. Learning objectives To understand the efficacy, patient‐centred outcomes, risk profile and cost‐effectiveness of various surgical modalities for the treatment of heavy menstrual bleeding in premenopausal women. To evaluate differing surgical approaches and techniques for hysterectomy and myomectomy, and their advantages and limitations. To be able to undertake informed counselling about the different surgical treatment modalities for heavy menstrual bleeding. Ethical issues Is it justified to offer hysterectomy as a first choice surgical option that entails increased morbidity but has higher satisfaction rates and is more cost‐effective? How can the continuing high rates of open abdominal hysterectomy be justified for a benign condition when the evidence clearly supports alternative routes? How are UK trainees to achieve the requisite skills to offer all surgical alternatives to women presenting with heavy menstrual bleeding within the present training system?

Surgical management of heavy menstrual bleeding: part 1

Key content Heavy menstrual bleeding affects one in five premenopausal women and significantly impairs quality of life. Management options for heavy menstrual bleeding are diverse and include a variety of medical and surgical treatments. Surgical treatment options are endometrial ablation, hysterectomy and myomectomy. Treatment choice for heavy menstrual bleeding should take into account the underlying pathology, the woman's preferences and fertility needs. Learning objectives To review the first‐ and second‐generation endometrial ablation techniques and evaluate the role of outpatient ablation. To discuss efficacy, safety, acceptability and cost‐effectiveness of various ablation techniques for the treatment of heavy menstrual bleeding in premenopausal women. Ethical issues Is it justified to offer endometrial ablation as a first choice surgical option for the management of heavy menstrual bleeding? Would a move to second‐generation ablation techniques result in loss of operative hysteroscopic skills that may be required for treating intrauterine pathology? With the rising trend of women having more than one caesarean section is it safe to use blind global ablative techniques?

A Randomized Controlled Multicenter US Food and Drug Administration Trial of the Safety and Efficacy of the Minerva Endometrial Ablation System: One-Year Follow-Up Results

Study ObjectiveTo assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatment of heavy menstrual bleeding in premenopausal women. DesignMulticenter, randomized, controlled, international study (Canadian Task Force classification I). SettingThirteen academic and private medical centers. PatientsPremenopausal women (n = 153) suffering from heavy menstrual bleeding (PALM-COEIN: E, O). InterventionPatients were treated using the Minerva Endometrial Ablation System or rollerball ablation. Measurements and Main ResultsAt 1-year post-treatment, study success (alkaline hematin ≤80 mL) was observed in 93.1% of Minerva subjects and 80.4% of rollerball subjects with amenorrhea reported by 71.6% and 49% of subjects, respectively. The mean procedure times were 3.1 minutes for Minerva and 17.2 minutes for rollerball. There were no intraoperative adverse events and/or complications reported. ConclusionThe results of this multicenter randomized controlled trial demonstrate that at the 12-month follow-up, the Minerva procedure produces statistically significantly higher rates of success, amenorrhea, and patient satisfaction as well as a shorter procedure time when compared with the historic criterion standard of rollerball ablation. Safety results were excellent and similar for both procedures.

Abnormal Uterine Bleeding: American College of Nurse-Midwives.

Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach.