Bleeding Patterns Research Articles

Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2.

Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive-aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM-COEIN. "PALM" refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and "COEI" refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The "N" is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive-aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 "PALM-COEIN" causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.

Platelet count threshold for hemorrhage in patients with immune thrombocytopenia treated with antiplatelet agents

A significant proportion of older patients with immune thrombocytopenia (ITP) also have clinical indications for treatment of cardiovascular disease with antiplatelet agents. Ollier and colleagues sought to determine the frequency of bleeding in patients with ITP on aspirin therapy, finding that the pattern of bleeding, segregated by platelet count, is similar to that observed in other adults with ITP not on aspirin. They show that a platelet count of <20 × 109/L is associated with most bleeding in ITP patients on antiplatelet agents.

Hormone sensitivity predicts the beneficial effects of transdermal estradiol on reward-seeking behaviors in perimenopausal women: A randomized controlled trial

Depression is highly prevalent during the menopause transition (perimenopause), and often presents with anxious and anhedonic features. This increased vulnerability for mood symptoms is likely driven in part by the dramatic hormonal changes that are characteristic of the menopause transition, as prior research has linked fluctuations in estradiol (E2) to emergence of depressed mood in at risk perimenopausal women. Transdermal estradiol (TE2) has been shown to reduce the severity of depression in clinically symptomatic women, particularly in those with recent stressful life events. This research extends prior work by examining the relation between E2 and reward seeking behaviors, a precise behavioral indicator of depression. Specifically, the current study utilizes a randomized, double blind, placebo-controlled design to investigate whether mood sensitivity to E2 flux (“hormone sensitivity”) predicts the beneficial effects of TE2 interventions on reward seeking behaviors in perimenopausal women, and whether recent stressful life events moderate any observed associations. MethodParticipants were 66 women who met standardized criteria for being early or late perimenopausal based on bleeding patterns. Participants were recruited from a community sample; therefore, mood symptoms varied across the continuum and the majority of participants did not meet diagnostic criteria for a depressive or anxiety disorder at the time of enrollment. Hormone sensitivity was quantified over an 8-week baseline period, using within-subjects correlations between repeated weekly measures of E2 serum concentrations and weekly anxiety (State Trait Anxiety Inventory) and anhedonia ratings (Snaith-Hamilton Pleasure Scale). Women were then randomized to receive 8 weeks of TE2 (0.1 mg) or transdermal placebo, and reward-seeking behaviors were assessed using the Effort-Expenditure for Rewards Task (EEfRT). ResultsParticipants who were randomized to receive transdermal estradiol and who demonstrated greater anxiety sensitivity to E2 fluctuations at baseline, demonstrated more reward seeking behaviors on the EEfRT task. Notably, the strength of the association between E2-anxiety sensitivity and post-randomization EEfRT for TE2 participants increased when women experienced more recent stressful life events and rated those events as more stressful. E2-anhedonia sensitivity was not associated with reward-seeking behaviors. ConclusionPerimenopausal women who are more sensitive to E2 fluctuations and experienced more recent life stress may experience a greater benefit of TE2 as evidenced by an increase in reward seeking behaviors.

Challenges in the classification of von Willebrand disease with a limited test panel: An experience from an upcoming hemostasis laboratory in southern India

Objectives: The diagnosis and classification of von Willebrand disease (VWD) is an intricate process requiring multiple hemostatic tests. Cutoff values of the tests vary with the subtype. Sometimes, all the tests are not available. This study was done to analyze the clinical and coagulation profile of VWD diagnosed and broadly classified based on a simplified algorithm. Material and Methods: This was a cross-sectional study done over 6 years. After screening tests, a simplified algorithm taking cutoff for various tests based on updated guidelines using the primary panel of von Willebrand factor antigen assay (VWF:Ag), VWF ristocetin cofactor activity (VWF:RCo), and Factor VIII:C was used. Multimer assay was done in a few cases. Data were compiled using summary statistics. Results: Forty patients fitted the diagnosis of VWD: Type 3 in 13 (32.5%), Type 2N (likely) in 8 (20%), Type 2 (not further categorized) in 9 (22.5%), and VWD, not further categorized in 10 (25%). The mean age was in the second or third decade with female predominance. Diagnosis of Type 3 was relatively straightforward due to markedly deranged parameters. Type 2N was provisionally diagnosed based on bleeding pattern and markedly reduced Factor VIII:C; further, subtyping of Type 2 and categorization of some cases was not possible due to non-availability of some tests. Conclusion: VWF:Ag assay, VWF:RCo, and Factor VIII:C form the cornerstone for diagnosing major VWD types. The under-representation of milder phenotypes and a greater proportion of severe VWD subtypes observed is likely due to hospital referral bias and may not represent population prevalence.

Hormone sensitivity and stressful life events predict the effects of transdermal estradiol on reward-seeking behaviors in perimenopausal women: A randomized controlled trial

Internalizing mood symptoms are highly prevalent during the menopause transition (perimenopause). Prior research demonstrates that perimenopausal women with greater estradiol (E2) variability are more likely to experience depression symptoms, especially following recent stressful life events (SLEs). Transdermal estradiol (TE2) has been shown to reduce the severity of depression in clinically symptomatic women, particularly in those with recent SLEs. This research extends prior work by examining the relation between E2 and precise behavioral indicators of depression, including reward-seeking behaviors. The current study utilizes a randomized, double blind, placebo-controlled design to investigate whether sensitivity to E2 flux predicts the effects of a TE2 intervention on reward-seeking behaviors in perimenopausal women, and whether SLE’s moderate any observed associations. Participants were 66 women who met standardized criteria for being early or late perimenopausal based on bleeding patterns. Hormone sensitivity was quantified over an 8-week baseline period, using within-subjects correlations between repeated weekly measures of E2 serum concentrations, anxiety symptoms, and anhedonia levels. Women were then randomized to receive 8 weeks of TE2 (0.1 mg) or transdermal placebo, and reward-seeking behaviors were assessed using the Effort-Expenditure for Rewards Task (EEfRT). There were no differences in EEfRT performance between randomized groups at baseline. Greater hormone sensitivity predicted more reward-seeking behaviors on the EEfRT task post-randomization, but only for participants randomized to TE2. Notably, the strength of this association increased when women experienced more SLEs. Perimenopausal women who are hormone sensitive with recent life stress may experience a greater benefit of TE2.

Kejadian anemia, pola menstrual bleeding dan status nutrisi pada siswi di SMAN 3 Salahutu, Maluku Tengah

Background: Anemia is a nutritional problem with a high incidence. Anemia is characterized by decreased hemoglobin (Hb) levels below normal. Adolescents are one of the groups at high risk of anemia because they experience menstrual cycles every month. Irregular menstrual bleeding patterns and nutrition can also be risk factors for anemia. Prevention of anemia is necessary to reduce the risk of anemia.Objectives: To determine the incidence of anemia, menstrual bleeding patterns, and nutritional status in female students at Salahutu Senior High School, Central Maluku.Methods: The study was descriptive and observational with a cross-sectional design. The study was conducted in October-December 2022 at Senior High School 3 Salahutu, Central Maluku. The number of subjects was 142, who met the inclusion criteria with an age range from 14 to 19 years. The research variables consisted of checking Hb levels using digital hb, and anthropometric measurements, namely BMI, and filling out questionnaires. Data analysis in this study used the Chi-square test at the 95% significance level.Results: The results showed that the number of age categories 16 years with the highest number of subjects, 35,9%, and underweight IMT category as much as 59,2%. The results of the anemia hemoglobin examination were 7,7%. The age of menarche is mainly at the age of 13 years 34,5%, and based on the length of menstruation, 3-5 days as much as 66,9% and 5-7 days as much as 29,6% with a menstrual cycle of 21-28 days as much as 59,9%. There was no relationship between nutritional status and duration of menstruation (p = 0,648) and Hb levels (p = 0,552). There is a relationship between nutritional status and menstrual cycle (p = 0,020).Conclusion: There is no relationship between nutritional status and duration of menstruation and Hb levels, but there is a relationship between nutritional status and menstrual cycle.

COCs with estradiol valerate/dienogest vs 17β-estradiol/nomegestrol acetate: effects on metabolism and body composition in menopausal transition women

Context: Women during the menopausal transition (MT) have reduced fertility, and yet frequency of pregnancy in the absence of contraception is about 30%. Late reproductive age women are at a higher risk of adverse pregnancy outcome, and thus require effective contraceptive methods if pregnancy is to be avoided. The use of combined oral contraceptives (COCs), in addition to highly effective pregnancy prevention, is associated with important non-contraceptive benefits for perimenopausal women, such as an improved bleeding pattern, particularly in the setting of irregular or heavy menses, alleviation of vasomotor symptoms. The main requirements in choosing СOCs for women during the MT are their safety, metabolic neutrality, and no weight gain, because during the MT occurs adverse changes in metabolic profile and body composition.

Not all traumatic brain injury patients on preinjury anticoagulation are the same

BackgroundPrognostic significance of different anticoagulants in TBI patients remains unanswered. We aimed to compare effects of different anticoagulants on outcomes of TBI patients. MethodsA secondary analysis of AAST BIG MIT. Blunt TBI patients ≥50 years using anticoagulants presenting ICH were identified. Outcomes were progression of ICH and need for neurosurgical intervention (NSI). Results393 patients were identified. Mean age was 74 and most common anticoagulant was aspirin (30%), followed by Plavix (28%), and coumadin (20%). 20% had progression of ICH and 10% underwent NSI. On multivariate regression for ICH progression, warfarin, SDH, IPH, SAH, alcohol intoxication and neurologic exam deterioration were associated with increased odds. Warfarin, abnormal neurologic exam on presentation, and SDH were independent predictors of NSI. ConclusionsOur findings reflect a dynamic interaction between type of anticoagulants, bleeding pattern & outcomes. Future modifications of BIG may need to take the type of anticoagulant into consideration.

Relationship of Job Stress with Menstrual Bleeding Pattern in Nurses

Relationship of Job Stress with Menstrual Bleeding Pattern in Nurses

Bleeding Patterns With Relugolix Combination Therapy in Women With Endometriosis-Associated Pain [ID: 1345374

INTRODUCTION: Relugolix combination therapy (Relugolix-CT: relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) significantly improved endometriosis-associated pain versus placebo in the SPIRIT 1&2 studies. Efficacy was maintained over 104 weeks in the long-term extension (LTE) study. Bleeding patterns in women treated up to 104 weeks with Relugolix-CT are reported. METHODS: SPIRIT 1&2 were IRB-approved phase 3, 24-week, randomized studies of Relugolix-CT, delayed Relugolix-CT (relugolix 40 mg monotherapy followed by Relugolix-CT; 12 weeks each), or placebo in premenopausal women (age 18–50 years) with moderate-to-severe endometriosis-associated pain. Eligible women completing SPIRIT 1&2 could enroll in the open-label LTE with once-daily Relugolix-CT. Bleeding days per cycle and bleeding patterns were recorded on eDiaries. Amenorrhea was defined as no bleeding over 28 consecutive days. RESULTS: Of 1,261 women originally randomized, 501 completed week 104. Baseline demographics and characteristics were balanced across treatment groups. The proportion of women achieving amenorrhea increased over time: 74.4% (95% CI 68.8–79.4) at week 24, and 82.3% (95% CI 74.6–88.4) at week 104. The average number of bleeding days per cycle (standard deviation) decreased over time from 5.8 (2.4) at baseline to 1.2 (3.3) at week 104. The number of heavy or extremely heavy bleeding days decreased from 1.9 at baseline to 0.0 at week 104. CONCLUSION: Treatment with Relugolix-CT in women with endometriosis-associated pain resulted in high rates of amenorrhea and complete elimination of heavy bleeding, thus demonstrating sustained benefit through 2 years. Findings may support patient counseling.

Novel Method for Management of Bothersome Bleeding Associated With Etonogestrel Drug Implant [ID: 1380127

INTRODUCTION: Nexplanon (etonogestrel drug implant [EDI]) is an effective, implantable subdermal contraceptive that releases progestin over 3 years for suppression of ovulation and thickening of cervical mucus. A significant portion of EDI patients will remove their device prematurely because of bothersome episodes of frequent/prolonged bleeding. In patients with abnormal uterine bleeding, induction of a withdrawal bleed, with the goal of reducing excessive bleeding, is a common approach. There is no standard approach to treating prolonged and/or excessive bleeding with EDI in place. METHODS: This is a randomized double-blinded placebo-controlled trial of 51 patients desiring EDI for contraception. Patients received norethindrone (NTA) 5 mg or placebo daily for 1 week every 4 weeks for a total of 6 months. RESULTS: No patients in the treatment arm requested removal because of bothersome bleeding as defined by International Federation of Gynecology and Obstetrics/World Health Organization criteria. In contrast, 24% of the placebo group participants requested removal of the device at or before 6 months from placement for a variety of reasons including bothersome bleeding. 9% from the treatment group requested early removal; however, none for bothersome bleeding. 80% of the treatment group participants had a satisfactory bleeding pattern. One participant in the treatment arm complained of unsatisfactory amenorrhea. CONCLUSION: We propose a novel method to manage bothersome bleeding associated with EDI. Our data suggest that cyclic NTA is an effective method to treat bothersome bleeding in patients using etonogestrel implants for contraception and warrants further study.

Contraceptive vaginal ring (MyRing®): multicenter study in Venezuelan women.

Objective: To evaluate the factors associated with the use of the vaginal ring in Venezuelan women of reproductive age, with a desire for contraception and with an active sexual life. Methods: Observational - descriptive, multicenter study. The sample was non-probabilistic, deliberate and voluntary. The vaginal ring was provided for three cycles and follow-up visits were made at the end of the first and third menstrual cycles. Acceptability, tolerability, compliance, menstrual cycle control, and the presence of adverse effects were evaluated. Results: A total of 140 women were included, whose mean age was 31.01 ± 8.14 years. The reasons for selecting the vaginal ring were: effectively prevents pregnancy (69.29 %), easy to use (68.57 %), method of monthly use (65.71 %). The bleeding pattern was reported as regular in 95% of the women in the second consultation and in 92.8% in the third; 88.57% reported absence of intermenstrual bleeding. There was adequate compliance in 97.86%; 96.43% expressed that it was easy to use and 92.86% comfortable at a sexual level. There were no statistically significant differences in the average weight at the second and third consultation (p > 0.05), nor in systolic and diastolic blood pressure (p > 0.05). There were no adverse events in 77%, when there were, the most frequent were headache, nausea and mastodynia; there were no serious adverse events or pregnancy. Conclusion: The contraceptive vaginal ring is a well-tolerated option with excellent acceptance, sexual and general satisfaction, safe, with few adverse events.

Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin

Some users of the etonogestrel contraceptive implant experience bothersome bleeding, which can reduce contraceptive satisfaction and continuation. Few strategies exist to manage this bleeding. The exact mechanism of progestin-induced bleeding is unknown, but it is likely multifactorial (eg, impaired angiogenesis, "leaky" fragile vasculature, and inflammation). Curcumin, the active ingredient in turmeric, has anti-inflammatory, antiproliferative, and antiangiogenic properties, which may make it a useful agent for implant-associated bothersome bleeding. This study aimed to evaluate whether curcumin decreases frequent or prolonged bleeding or spotting in contraceptive implant users. The study was a randomized, double-blind, placebo-controlled trial. Here, etonogestrel implant users with frequent or prolonged bleeding or spotting were enrolled and randomized to either 600-mg Theracurmin HP (Immunovites, Las Vegas, NV) or placebo daily for 30 days. The term "frequent" was defined as ≥2 independent bleeding or spotting episodes, and the term "prolonged" was defined as ≥7 consecutive days of bleeding or spotting in a 30-day interval. Implant use was confirmed by clinical examination and negative gonorrhea and chlamydia and pregnancy tests. Enrolled participants initiated study treatment after 3 consecutive days of bleeding or spotting; if no bleeding or spotting occurred within 30 days of enrollment, the participants were withdrawn from the study. Study treatments were encapsulated to maintain a similar appearance. Participants used text messages to record daily bleeding patterns and study drug compliance. Bleeding was defined as a day that required the use of protection with a pad, tampon, or liner, and spotting was defined as a day with minimal blood loss that did not require the use of any protection. Our primary outcome was the total number of days without bleeding or spotting during the 30 days of study drug or placebo exposure. The secondary outcomes included total number of bleeding-free days, bleeding episodes, and satisfaction. A sample size of 22 per group provided 80% power at an alpha level of .05 to demonstrate a 6-day difference between groups. From February 2021 to November 2022, 58 individuals enrolled in the study with 54 participants (93%) completing 30 days of treatment (26 in the curcumin group and 28 in the placebo group). Of note, 1 individual in the curcumin arm did not experience a qualifying bleeding event and, thus, never initiated treatment and, per protocol, was withdrawn from the study. Participant characteristics did not differ between groups, including length of implant use at study enrollment (placebo, 521±305 days; curcumin, 419±264 days). The study groups did not differ concerning any bleeding-related outcome (mean days without bleeding or spotting: curcumin, 16.7±6.9; placebo, 17.5±4.8; P=.62; mean bleeding-free days: curcumin, 23.4±4.9; placebo, 22.4±4.5; P=.44; bleeding episodes: curcumin, 2.0±0.8; placebo, 2.1±0.8; P=.63). In addition, satisfaction with the implant as contraception and acceptability of bleeding over the study period did not differ by study group (P=.54 and P=.30, respectively). Daily use of curcumin did not improve bleeding patterns in users of the etonogestrel contraceptive implant experiencing frequent or prolonged bleeding patterns.

AN OBSERVATIONAL STUDY OF ASSOCIATION OF SUBCLINICAL HYPOTHYROIDSIM AND ABNORMAL UTERINE BLEEDING

Introduction Abnormal uterine bleeding is a common gynecological presentation, accounting for atleast 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty anovulatory cycles, and abnormally high fetal wastage. Hence,this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. Aim & Objective: 1. To estimate the Prevalence & association of subclinical hypothyroidism among women presenting with abnormal uterine bleeding.Methods: A descriptive cross-sectional study was conducted in 250 patients with abnormal uterine bleeding in a tertiary care hospital. Data was collected using a questionnaire which includes patients prole ,the pattern of abnormal uterine bleeding, and thyroid prole. Settings and Design: This study was done in a MGM medical college indore & myh hospital in Madhya Pradesh. Results: Out of 250 patients presenting with AUB, 163 (71.6%) were euthyroid, 20 (3.6%) were overt hypothyroid, and 10 (0.5%) was hyperthyroidism and 57 ( 24.2%) were subclinical hypothyroidsim. the mean levels of the thyroid-stimulating hormone were 4.28 ± 2.76 mIU/L. The mean triiodothyronine and thyroxine were 132.6 ± 34.90 and 9.81 ± 3.60, respectively The most common symptom abnormal uterine bleeding was menorrhagia 74 (29.8%), followed by polymenorrhoea 53 (21.4%), hypomenorrhoea 32 (12.9%) , intermenstrual bleeding 31(12.5%), acyclicalbleeding 6 (2.8%) and oligomenorrhea 3 (1.2%). The maximum number of patients was between 41-50 years with the mean age of 41years. Conclusion: There is signicant association between subclinical hypothyroidism and abnormal uterine bleeding The prevalence of subclinical hypothyroidism in the study group was 24.2% It is suggested that women with early onset menorrhagia and oligomenorrhea with or without symptoms & signs attributable to thyroid dysfunction should be offered thyroid function testing to detect subclinical stage Early detection by selective screening and specic pharmacotherapy for subclinical thyroid disease early in the course of the disease will prove to be a superior alternative to surgical treatments like hysterectomy

More than blood: app-tracking reveals variability in heavy menstrual bleeding construct

BackgroundHeavy menstrual bleeding (HMB) is associated with impaired quality of life and may signal serious health problems. Unresolved challenges in measuring menstrual bleeding and identifying HMB have hampered research and clinical care. Self-reported bleeding histories are commonly used but these may be influenced by recall bias, personal beliefs regarding “normal” flow volume, and the experience of other physical symptoms or disruptions to daily life. The potential usefulness of menstrual-tracking mobile applications, which allow real-time user-entered data recording, for assessing HMB has not been studied. We evaluated recall bias in reported period duration, the relationship of tracked period duration and daily flow volume to subsequently reported period heaviness, variation in quality of life associated with increasing period heaviness, and the advantages and limitations of using app-tracked data for clinical and research purposes.MethodsAn online questionnaire was distributed to current users of Clue, a commercially available menstrual health tracking app, asking them to characterize their last period. We compared responses to the user’s corresponding Clue app-tracked data. The study sample comprised 6546 U.S.-based users (aged 18–45 years).ResultsIncreasing reported heaviness was associated with increasing app-tracked period length and days of heavy flow, impaired quality-of-life (especially body pain severity), and disrupted activities. Of those reporting having had a heavy/very heavy period, ~ 18% had not tracked any heavy flow, but their period length and quality-of-life indicators were similar to those who had tracked heavy flow. Sexual/romantic activities were the most affected across all flow volumes. Compared to app-tracked data, 44% recalled their exact period length; 83% recalled within ± 1 day. Overestimation was more common than underestimation. However, those with longer app-tracked periods were more likely to underestimate period length by ≥ 2 days, a pattern which could contribute to under-diagnosis of HMB.ConclusionPeriod heaviness is a complex construct that encapsulates flow volume and, for many, several other bleeding-associated experiences (period length, bodily impairments, disruptions of daily activities). Even very precise flow volume assessments cannot capture the multi-faceted nature of HMB as experienced by the individual. Real-time app-tracking facilitates quick daily recording of several aspects of bleeding-associated experiences. This more reliable and detailed characterization of bleeding patterns and experiences can potentially increase understanding of menstrual bleeding variability and, if needed, help to guide treatment.

Thyroid Disorders in Reproductive Females with Abnormal Uterine Bleeding

Methodology: One hundred outpatient females who were having difficulties related to their thyroid bleeding were accepted into the study. Patients with ages ranging from 40 to 55 years were included in this study. Every lady was evaluated to establish whether or not she was suffering from abnormal uterine bleeding, and her thyroid profile was analyzed as well. The procedure for the research study consisted of getting a detailed history from the participants regarding any anomalies in their periods. In addition to these, standard blood tests including random blood sugar, haemoglobin, erythrocyte sedimentation rate, liver function test, pap smear, bleeding time, clotting time, endometrial biopsy, transvaginal ultrasonography and transabdominal, serum T3 (T3), T4 (T4), and thyroid stimulating hormone (TSH) were performed. These tests were carried out on the patient. Results: Mean age as 46.8+5.98 years and mean BMI was calculated as 27.98+6.21(kg/m2). Mean TSH levels were 4.4+2.5(mIU/L), T3 level were 3.4 ± 1.7 (pmol/L), and T4 level were 1.8 ± 0.6 (pmol/L). We found Menorrhagia as the commonest bleeding pattern 49(49%) followed by Oligomenorrhea in 30(30%), Hypomenorrhea in 11(11%) and Metrorrhagia in 2(2%) of the cases. Conclusion: Among the patients with abnormal uterine bleeding, hypothyroidism was common finding and hyperthyroidism was associated with lesser amount of bleeding. Moreover abnormal BMI is a major risk factor for the abnormal uterine bleeding. Keywords: Abnormal uterine bleeding, hypothyroidism, body mass index

Patient satisfaction, sexual function and decision regret in use of levonorgestrel intrauterine device

Aim: Abnormal uterine bleeding is a common condition. The etiological cause and treatments are diverse. LNG-IUD can be used to treat abnormal uterine bleeding.It has been shown to reduce the amount of bleeding in patients with menorrhagia and increase hemoglobin and hematocrit (Hct) values. The aim is to investigate the effects of LNG-IUD on hemoglobin, Hct, bleeding pattern, and its effect on sexual function, decision regret, and menorrhagia effects according to the etiologic cause.
 Material and Method: Our study included patients who underwent LNG-IUD implantation and had been using it for over six months. Patients with a history of postmenopausal or adolescent bleeding, hematologic or oncologic diseases, and a history of drug use that may cause coagulation disorders were excluded. Patients were grouped according to their indications as polyp (n=26), adenomyosis (n=16), leiomyoma (n=27), hyperplasia (n=18), and non-structural causes (n=81). Hemoglobin (Hb) and Hct values were examined before and after the application, and bleeding patterns were questioned. Participants were administered Menorrhagia Impact Questionnaire (MIQ), Arizona Sexual Experience Scale and Decision Regret Scale. 
 Results: 168 patients were included in our study. The average duration of LNG-IUD use was 627.0±319 days and the average age was 43.4±6.1 years. The frequency of bleeding (number of bleedings per year) was 18.0±8.0 before LNG-IUD application and 7.8±8.0 after treatment (p

Comparison of Bleeding Pattern and Quality of Life Before and After the Insertion of a Levonorgestrel Intrauterine System for Heavy Menstrual Bleeding: A Seven-Year Review.

Background This study aimed to examine the role of a levonorgestrel intrauterine system (LNG-IUS) in the treatment of heavy menstrual bleeding (HMB) regarding improvements in bleeding patterns and quality of life (QOL) and determine the reason for its failure or withdrawal from treatment in some patients. Methodology This retrospective study was conducted in a tertiary care center in eastern India. A seven-year assessment, with both qualitative and quantitative assessments, of the effect of LNG-IUS in women with HMB was performed using the Menorrhagia Multiattribute Scale (MMAS) and Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) score as a tool to assess the QOL, and the pictorial bleeding assessment chart (PBAC) to assess bleeding patterns. The study population was divided into the following four groups based on duration: three months to one year, one to two years, two to three years, and more than years.The continuation, expulsion, and hysterectomy rates were evaluated. Results The mean MMAS and MOS SF-36 scores increased significantly (p < 0.05) from 36.73 ± 20.40 to 93.72 ± 14.62 and 35.33 ± 6.73 to 90.54 ± 15.89, respectively. The mean PBAC score decreased from 176.36 ± 79.85 to 32.19 ± 63.87. In total, 348 women (94.25%) continued the LNG-IUS, and 3.44% had uncontrolled menorrhagia. Furthermore, at the end of seven years, the expulsion rate was 2.28% due to adenomyosis and pelvic inflammatory disease, and the hysterectomy rate was 5.75%. In addition, 45.97% and 48.27% of the participants had amenorrhea and hypomenorrhea, respectively. Conclusions LNG-IUS improves bleeding and QOL in women with HMB. In addition, it requires less skill and is a non-invasive and nonsurgical option, which should be considered first.

Outcomes of Menstrual Management Use in Transgender and Gender-Diverse Adolescents.

To describe and compare the outcomes of various menstrual-management methods, including method choice, continuation, bleeding patterns, amenorrhea rates, effect on moods and dysphoria, and side effects, in transgender and gender-diverse adolescents. This was a retrospective chart review of all patients seen in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, had achieved menarche, and used a menstrual-management method during the study period. Data were abstracted on patient demographics and menstrual-management method continuation, bleeding patterns, side effects, and satisfaction at 3 months (T1) and 1 year (T2). Outcomes were compared between method subgroups. Among the 101 included patients, 90% chose either oral norethindrone acetate or a 52-mg levonorgestrel (LNG) intrauterine device (IUD). There were no differences in continuation rates for these methods at either follow-up time. Almost all patients had improved bleeding at T2 (96% for norethindrone acetate and 100% for IUD users), with no difference between subgroups. Amenorrhea rates were 84% for norethindrone acetate and 67% for IUD at T1 and 97% and 89%, respectively, at T2, with no differences at either point. The majority of patients had improved pain, menstrually related moods, and menstrually related dysphoria at both follow-up points. There were no differences in side effects between subgroups. There were no differences in method satisfaction between the groups at T2. Most patients chose norethindrone acetate or an LNG IUD for menstrual management. Continuation, amenorrhea, and improved bleeding, pain, and menstrually related moods and dysphoria were high for all patients, indicating that menstrual management is a viable intervention for gender-diverse patients who experience increased dysphoria related to menses.

Bleeding-related re-exploration following pulmonary resection: a report of a single-center experience.

Postoperative bleeding is a potentially fatal complication after lung surgery and usually requires re-operation. The aim of this study was to analyze the characteristics of bleeding-related re-exploration following pulmonary resection and reduce the incidence of this complication. From January 2016 to December 2020, 14,104 patients underwent pulmonary resection for lung cancer or pulmonary nodule at Fudan University Shanghai Cancer Center, China. We evaluated cases with bleeding-related re-exploration, and analyzed the relationship between postoperative bleeding and clinical characteristics. We further developed a protocol to reduce the proportion of bleeding-related re-exploration in our center. Bleeding-related re-exploration occurred in 85 (0.60%) out of 14,104 patients. The sources of postoperative bleeding included surgical incision (20, 23.53%), parietal pleura (20, 23.53%), bronchial artery (14, 16.47%), lung parenchyma (13, 15.29%), pulmonary vessel (5, 5.88%) and rare source of bleeding. There were various patterns of postoperative bleeding. Open thoracotomy had a significantly higher bleeding rate than video-assisted thoracoscopic surgery (VATS) (1.27% vs 0.34%, p < 0.0001). The bleeding rate of pneumonectomy, lobectomy, segmentectomy and wedge resection was significantly different (1.78%, 0.88%, 0.46% vs 0.28%, p < 0.0001). All patients were discharged successfully except for one patient died of respiratory failure. A protocol based on these findings was developed to reduce the proportion of bleeding-related re-exploration in our center. Our findings revealed that the source of bleeding, surgical approach and procedure affected the pattern of postoperative bleeding. Postoperative bleeding could be managed properly on the timely decision of re-exploration considering its origin, severity, onset and risk factors.