Pictorial Chart Score Research Articles

A prospective study on the effects of levonorgestrel-releasing intrauterine system for adenomyosis with menorrhagia

To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study. From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients' parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed. Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1- 60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P<0.01), the scroes of menstruation were 157±34, 94±35, 70±33, 67±18, 67±20, 65±19, 66±19, 65±21 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 24 months after placement of LNG-IUS, pictorial chart scores and distribution of anemia had improved significantly compared with preceding period (all P<0.01). We found no dependent factors predicting improvement of pictorial chart scores of menorrhea, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05). LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.

Levonorgestrel‐intrauterine system effects on hemostasis and menstrual blood loss in women seeking contraception

The purpose of the study is to determine the effects of levonorgestrel use on hemostasis, and menstrual blood loss over 24 months in a cohort of women seeking contraception. Data from 30 women (median age 36 years) were analyzed. Samplings at pre-insertion, 1 and 3 months for blood and additional endometrial aspirates at 2 and 6 months were performed. Systemic determination for hemoglobin, hematocrit, computerized thromboelastography, tissue-type plasminogen activator, urokinase-like plasminogen activator and receptor, plasminogen activator inhibitor-1/2, D-dimer and von Willebrand Factor was performed. In endometrial extracts, tissue-type plasminogen activator, urokinase-like plasminogen activator and receptor and plasminogen activator inhibitor-1/2 were assayed. The Menstrual Blood Loss Pictorial Chart Score for measurement of menstrual blood loss was carried out for 24 months. There were no significant changes in systemic hemostasis within 3 months of device use. In the endometrium, there was a significant increase in tissue-type plasminogen activator antigen, plasminogen activator inhibitor-1/2 and urokinase-like plasminogen activator receptor levels from pre-insertion state, with the highest level seen by 6 months. Amenorrhea was seen in 20% of women by 6 months and 50% by 24 months. Enhanced expression of plasminogen activator inhibitor-1/2 in the presence of increased urokinase-like plasminogen activator receptor and tissue-type plasminogen activator antigen was seen in the endometrium. The effects on hemostasis appear to be localized in the endometrium. Systemic hemostasis was not duly affected and menstrual blood loss was reduced. No women in the study had a pregnancy or expulsion of the levonorgestrel-intrauterine system device in the 24 months of the study period.

Preventive treatment of intrauterine device‐induced menstrual blood loss with tranexamic acid in Chinese women

To investigate whether tranexamic acid (Transamin) therapy reduces the amount of menstrual blood loss (MBL) and occurrence of menorrhagia after intrauterine device (IUD) insertion. Some 175 Chinese women attending for IUD insertion were equally assigned into 2 Transamin groups (1,000 and 500 mg, twice daily) and a placebo group. Their MBL was recorded with a pictorial chart in 3 subsequent menstrual cycles after insertion, while the MBL of 64 patients, collecting used sanitary towels, was also measured by an alkaline hematin method. A significant decline in post-insertion MBL and occurrence of menorrhagia was found in the 2 Transamin groups compared with the placebo group (p<0.05), whereas the difference in the results from the pictorial chart score was not statistically significant between the 1 g group and placebo group. Transamin treatment with a generally recommended dosage can effectively reduce the amount of IUD-induced MBL and prevent menorrhagia in Chinese women. A lower dosage than recommended (50% of recommended dosage) may have a similar preventive effect.

The use of levonorgestrel‐releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders

The levonorgestrel-releasing intrauterine system (LNG-IUS) is used commonly by gynaecologists as a contraceptive and to treat menorrhagia. However, its efficacy has not been examined in women with inherited bleeding disorders. A prospective pilot study. A teaching hospital in north London with a designated haemophilia centre. Female patients with a known inherited bleeding disorder. Sixteen women with subjective and objective menorrhagia caused by inherited bleeding disorders (13 von Willebrand's Disease, two factor XI deficiency and one Hermansky-Pudlak syndrome), who had previously undergone unsuccessful medical treatment were followed up for nine months after LNG-IUS insertion. Bleeding was measured by pictorial chart and haemoglobin concentration. All women reported that their periods were improved, pictorial chart scores were lower and 56% became amenorrhoeic. None reported side effects. The LNG-IUS is well tolerated and effective and improves quality of life.

Decreased platelet dense granule number and volume associated with menorrhagia

Background: The role of platelets in menorrhagia has not been fully studied. One candidate platelet (PL) defect is dense granule (DG) deficiency (DGD), a heterogeneous bleeding diathesis characterized by variable abnormalities in PL aggregation and decreased DG number by electron microscopy (EM). Additionally, DG volume deficiency can produce a storage pool defect analogous to that of typical platelet DGD.Objective: To determine platelet DG number and total DG volume (TDGV) in a subset of consecutive menorrhagia patients participating in an ongoing study of the prevalence of von Willebrand’s disease (vWd) in menorrhagia in Rochester, NY.Methods: Females were recruited presenting with menorrhagia within the previous 12 months with a pictorial chart score of menses of more than 100. Ultrastructural evaluation of DGs was performed on whole mounted platelets using standard EM methods.Results: To date, the last 31 consecutive patients (PCS >100) have been evaluated for DG storage pool deficiency with a mean DG number of 2.56 ± 1.26 (normal: 5.04 ± 0.51 DG/PL); 26/31 (84%) have a mean DG number of more than 3 standard deviations below the normal mean (<3.68 DG/PL). Mean TDGV is 3.98 ± 2.26 × 106 nm3/PL (normal: 10.89 ± 1.22 × 106 nm3/PL). In 16 of 31 (52%) patients, there were more than two additional bleeding symptoms; 23 of 31 (74%) have normal vWf levels.Conclusions: In a cohort of patients with menorrhagia undergoing testing for vWd, all patients have decreased TDGV, and more than 80% have decreased DG number. Whether the defect of the dense granules is acquired or inherited, and is a cause or consequence of menorrhagia, merits further study.

The semi-quantitative assessment of menstrual flow in relation to clinical and hematological parameters

The hemostasis of menstruation has not been extensively studied particularly since the development of laboratory tests for von Willebrand factor, a glycoprotein that plays a critical role platelet aggregation. Objective: To determine the relationship of menstrual flow to clinical and hematological parameters. Methods: We studied 155 (56 blood type O/99 blood type non-O) normal female volunteers that met the following criteria: age 12–50; not taking an oral contraceptive, estrogen, or Coumadin; not pregnant; regular periods. A questionnaire was administered regarding the patient’s medical history. A pictorial chart score of menstrual blood flow was obtained using standard tampons/pads for all participants; this semi-objective measure has previously been validated to be diagnostic of menorrhagia at a score of >185. Menstrual coagulation sampling was within the first 3 days of the cycle. We then analyzed by multiple linear regression analysis the pictorial chart score assuming a log-normal distribution as a dependent variable with the following clinical and laboratory parameters as independent variables. Results: The mean age was 35.7 ± 7.4 years. The mean pictorial chart score was 119.1 ± 76.3. ∗ Independent Variable With Pictorial Chart Score as Dependent Variable Parameter Estimate (slope) P Value (two-sided) Age 0.007 .2 Number of prior births 0.16 .02 Blood group type −0.06 .3 Hematocrit −0.01 .3 Factor VIII activity 0.002 .1 von Willebrand factor activity (ristocetin cofactor) 0.001 .3 von Willebrand factor antigen −.003 0.04 ∗ ∗ P value is one-sided (an inverse association was hypothesized). Conclusion: A history of prior births and laboratory evidence of a low von Willebrand factor antigen appear to predict for increased menstrual flow; studies are ongoing in applying these parameters in women presenting with menorrhagia.

Assessment of menstrual blood loss using a pictorial chart

Objective menstrual blood loss measurements (in ml) were compared with the score obtained from a pictorial blood loss assessment chart (PBAC) which took into account the degree to which each item of sanitary protection was soiled with blood as well as the total number of pads or tampons used. Twenty eight women used the chart during 55 menstrual cycles and a single observer assessed 122 cycle collections in a similar manner. A pictorial chart score of 100 or more, when used as a diagnostic test for menorrhagia, was found to have a specificity and sensitivity of greater than 80%. Demonstration of the relation between self assessed pictorial chart scores and the objective measurement of blood loss enables us to provide a simple, cheap and reasonably accurate method of assessing blood loss before embarking upon treatment.