Prevalence Of Heavy Menstrual Bleeding Research Articles

Community screening for iron deficiency in reproductive aged women: Lessons learnt from Australia.

Reproductive-aged women are at an increased risk of developing iron deficiency (ID). We aimed to develop a non-invasive screening tool to identify ID in women and assess the acceptability of screening. We screened women (age 18-49 years) in the community of Western Australia. acceptability of screening, assessed by the feasibility of recruiting the required sample size (n = 323). Hand grip strength, finger prick haemoglobin concentration (Hb), prevalence of heavy menstrual bleeding (HMB), diet, pregnancy history, blood donation, symptoms of ID and history of ID or anaemia (Hb < 120 g/L). Those with Hb <130 g/L and no history of iron therapy in the past 2 years were given referrals for venous full blood count and ferritin sampling. Across 5 days, we recruited 640 eligible women. Of which, 178 (28%) had HMB and 79 (12%) were anaemic. Mean age was 33.5 ± 9.2 years, and mean Hb was 132.4 ± 11.9 g/L. In the past 2 years: 335 (52%) were diagnosed with ID or anaemia; 322 (50%) had taken oral iron; and 210 (33%) had an intravenous iron infusion. Vegetarian diets were followed by 89 (14%); 40 (6%) were regular blood donors; 290 (45%) had a previous pregnancy. HMB increased the risk of symptoms of ID and having prior ID/anaemia diagnosis (67% vs. 47%) or treatment (p < 0.022). Hand grip strength showed a positive relationship with both Hb (adjusted R2 = 0.012, p = 0.004) and ferritin (adjusted R2 = 0.135, p = 0.005). ID screening was well accepted by women in the community, with high recruitment rates over a short period. Future screening tool development may consider incorporating hand grip strength and HMB assessment.

Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review

BackgroundThe effects of antiplatelet therapy on menstrual bleeding have not been well characterized. ObjectivesTo systematically review the effects of antiplatelet therapy on menstrual bleeding. MethodsA literature search was performed for studies of reproductive-aged women who received antiplatelet therapy. Characteristics of menstrual bleeding both before and after initiation of antiplatelet therapy and from comparison groups were collected. Two reviewers independently assessed the risk of bias in individual studies. ResultsThirteen studies with a total of 611 women who received antiplatelet therapy were included. Types of antiplatelet drugs used were aspirin (n = 8), aspirin and/or clopidogrel (n = 2), prasugrel (n = 1), and not specified (n = 2). Risk of bias was assessed at moderate (n = 1), serious (n = 8), critical (n = 2), and no information (n = 2). Three studies reported changes in menstrual blood loss volume. One of these showed no increase during antiplatelet therapy; the other 2 studies suggested that aspirin may increase menstrual blood loss volume. In 3 studies that assessed the duration of menstrual bleeding, up to 13% of women reported an increased duration of menstruation. In 5 studies that reported the intensity of menstrual flow, 13% to 38% of women experienced an increase in the intensity of flow. Five studies reported the prevalence of heavy menstrual bleeding in women who received antiplatelet therapy, with estimates ranging from 7% to 38%. ConclusionThere is lack of high-quality data on the effects of antiplatelet therapy on menstrual bleeding. Aspirin may increase menstrual blood loss, at least in a minority of women, whereas the effects of P2Y12 inhibitors are unknown.

Heavy Menstrual Bleeding in Adolescents on Direct Oral Anticoagulants

Background Direct oral anticoagulants (DOACs) - Dabigatran, Rivaroxaban, and Apixaban - are increasingly being used in the pediatric and adolescent population. DOACs have been shown to increase the likelihood of heavy menstrual bleeding (HMB) in adult women of childbearing age, when compared to vitamin K antagonists or low molecular weight heparins (LMWH). There are limited data regarding the prevalence of HMB in the adolescent population on DOACs. Pivotal trials leading up to the approval of DOACs in the adolescent and pediatric populations also failed to prespecify prospective analyses on the impact of DOACs on HMB. The effect of HMB and its treatment burden can contribute to the compliance rates of DOACs in this population, adding to the recurrence rates of venous thromboembolism. Our study aims to assess the rate of HMB with DOAC use in adolescents by comparing the rate of HMB and its associated healthcare burden to patients on other anticoagulants. Methods This is a retrospective cohort study conducted with deidentified data obtained from the Pediatric Health Information System (PHIS) database after IRB approval. The PHIS is a comparative database with clinical and resource utilization data for inpatient, ambulatory surgery, ED, and observation unit encounters from more than 49 children's hospitals. ICD-10 codes were used to query the data for pediatric patients between the ages of 9-18 years on anticoagulant therapy from January 2020-December 2022. DOAC group was defined as patients on Rivaroxaban, Dabigatran, or Apixaban at any point in their care. The control group was defined as patients on anticoagulants other than DOACs, such as LMWH, unfractionated heparin, coumadin, and bivalirudin. Data extracted included any episode of HMB (diagnosis codes for abnormal uterine bleeding, dysfunctional uterine bleeding, menorrhagia, or heavy menstrual bleeding), risk factors for HMB other than anticoagulants, and healthcare utilization data for HMB such as number of ED visits, hospital admission and length of stay, and ICU admission. For the Descriptive statistics, demographics and clinical characteristics of the patients were described using median and interquartile range (25th percentile, 75th percentile) for continuous variables, and frequency and percentages for categorical variables, as appropriate. Control group was matched to the DOAC group by propensity score matching using nearest method with the ratio 1:5 to generate the similar pairwise comparison. Categorical variables were analyzed with the chi-square test; continuous variables were assessed by Mann Whitney U test or Kruskal-Wallis rank sum test. P-value of less than 0.05 was considered as statistically significant for the analysis. All the analysis were performed using SAS software, version 9.4 (SAS Institute, Cary, NC) and R software, version 4.2.2 Results Of the total sample size of 87,119 patients on any anticoagulant, 84,411 (96.8%) patients were in the control group and 2,708 (3.1%) in the DOAC group before propensity matching. Of the three DOACs studied, 2013 were in Rivaroxaban group (74%), followed by Apixaban (671 or 25%) and Dabigatran (24 or 1%). Rates of HMB in patients on the largest DOAC group, Rivaroxaban vs the control group, and Rivaroxaban vs Apixaban are as shown in table 1.There was no significant difference in healthcare burden between the DOAC and control groups (p-value 0.954) with no difference in length of stay between the two groups (5 days for both groups). The rate of HMB with the use of DOACs or with known risk factors of HMB on any anticoagulant is as shown in table 2. Conclusion In contrast to adult patients, our study suggests similar rates of HMB in adolescents on DOACs when compared to the control group. Rivaroxaban was the most commonly used DOAC in our data set. Though the number of patients on Apixaban was small, there was no difference in the rate of HMB between Rivaroxaban and Apixaban groups. Patients with known risk factors of HMB had an increased rate of HMB with all anticoagulants. Prospective studies are needed to further elucidate the impact of DOACs and other anticoagulants on HMB in adolescents.

Assessment of menstrual health in adolescent and young adults with sickle cell disease.

Sickle cell disease (SCD) is associated with hypercoagulability, but adults with SCD also have an increased incidence of bleeding including heavy menstrual bleeding (HMB). HMB is common among adolescent females, but the impact of HMB in pediatric SCD is unclear. The objectives of this study were to examine menstrual health status, knowledge, and quality of life (QOL). We performed a single-institutional multi-clinic cross-sectional study comprised of a five-part survey in pediatric participants with SCD. The survey included the validated Menstrual Bleeding Questionnaire (MBQ) and Self-administered Bleeding Assessment Tool (Self-BAT). Forty-eight participants with a median age of 16years (range: 12-21years) completed the study. The mean age at onset of menarche was 13±1.3years. On the MBQ, 29% reported heavy/very heavy menstrual flow, 61% reported moderate or severe dysmenorrhea, and 96% had menses lasting less than 1week. The Self-BAT revealed that 42% of participants reported a history of HMB. Participants with severe dysmenorrhea or HMB had higher MBQ scores, corresponding to worse QOL. Despite this, less than 20% of participants had attempted any hormonal therapy for menstrual regulation. The odds of hormonal therapy utilization were comparable among participants on hydroxyurea versus not on hydroxyurea (odds ratio 1.58, 95% confidence interval [CI]: 0.33-7.56). The prevalence of HMB and dysmenorrhea is high among adolescents and young women with SCD. Strategies that incorporate menstrual health assessment into routine medical care in this population would help address this important area of pediatric health.

Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study

Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes. Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes. 4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β -3·34, 95% CI -7·04 to 0·37). Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem. Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.

PB0205 High Prevalence of Heavy Menstrual Bleeding in Women with Rare Bleeding Disorders in the Netherlands: Retrospective Data from the RBiN Study

PB0205 High Prevalence of Heavy Menstrual Bleeding in Women with Rare Bleeding Disorders in the Netherlands: Retrospective Data from the RBiN Study

High prevalence of heavy menstrual bleeding in women with rare bleeding disorders in the Netherlands: retrospective data from the RBiN study

BackgroundHeavy menstrual bleeding (HMB) is associated with a reduced quality of life and limitations in social and physical functioning. Data on HMB in women with rare bleeding disorders (RBDs), including coagulation factor deficiencies and fibrinolytic disorders, are scarce. ObjectivesTo analyze the prevalence, severity, and treatment of HMB in Dutch women with an RBD. MethodsThe Rare Bleeding Disorders in the Netherlands (RBiN) study included 263 patients with an RBD from all 6 hemophilia treatment centers (October 2017-November 2019). In this analysis, data of 111 women aged ≥16 years were studied. According to the International Society on Thrombosis and Haemostasis bleeding assessment tool, HMB symptoms were scored from 0 (no/trivial) to 4 (severe symptoms requiring medical intervention). HMB was defined as a score ≥1. Age at RBD diagnosis was extracted from patient files. ResultsHMB was reported by 80% of women (89/111) and was more prevalent in women with a fibrinolytic disorder (33/35; 94%) than in women with a coagulation factor deficiency (56/76; 74%) (P = .011). Of the 89 women with HMB, 82% (n = 73) ever required treatment. Multiple treatment modalities were frequently used, both in severe and mild deficiencies. Hormonal treatment was mostly used (n = 64; 88%), while antifibrinolytics were prescribed less frequently (n = 18; 25%). In women with HMB since menarche (n = 61; 69%), median age at RBD diagnosis was 28 years (IQR, 14-41). ConclusionHMB is common in women with RBDs. Women with mild deficiencies also frequently reported HMB. Only a minority of women were treated with hemostatic agents. A significant diagnostic delay was observed after the onset of HMB symptoms.

Prevalence of Heavy Menstrual Bleeding and Its Associated Factors Among Women Attending Kilimanjaro Christian Medical Centre In Northern Eastern, Tanzania: A Cross-Sectional Study.

Women of reproductive age experience a lower quality of life and considerable morbidity as a result of heavy menstrual bleeding. This issue needs to be addressed to achieve gender equality and permit women and girls to engage in a range of economic activities. In this study, we aimed to determine the prevalence and the most common factors associated with heavy menstrual bleeding. Cross-sectional study was conducted at a zonal referral hospital in Northern Eastern, Tanzania. Data was extracted from women files who attended the hospital obstetrics and gynaecology clinic retrospectively. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to summarize the data. A univariate logistic regression model was fitted to assess the strength of the association between heavy menstrual bleeding and exposure variables. A total of 162 women aged 15-54 years were enrolled. The prevalence of heavy menstrual bleeding was found to be 24.1%. The following factors were found to be significantly associated with heavy menstrual bleeding; age range of 20-44 years (OR: 0.16;95% CI: 0.02-1.01), hormonal contraceptives (OR: 3.16; 95% CI: 1.15-8.69), having no clots on menstrual blood (OR: 0.19; 95% CI: 0.58-0.651), low haemoglobin level (OR: 5.61; 95% CI: 1.44-21.90), and uterine fibroid (OR: 0.35; 95% CI: 0.17-0.73). Despite the extreme measurements of Heavy Menstrual Bleeding (HMB) in this study, its prevalence remained high. To spread awareness of HMB and its consequences, we recommend screening the general public and offering health education initiatives.

Prevalence of Heavy Menstrual Bleeding and Associations with Physical Health and Wellbeing in Low- and Middle-Income Country Settings: A Multinational Cross-Sectional Survey

Prevalence of Heavy Menstrual Bleeding and Associations with Physical Health and Wellbeing in Low- and Middle-Income Country Settings: A Multinational Cross-Sectional Survey

Prevalence of Heavy Menstrual Bleeding and Use of Hormonal Therapy Among Women Type 1 Von Willebrand Disease from the Zimmerman Program

Background: Women with von Willebrand disease (VWD) experience substantial reproductive tract bleeding, including heavy menstrual bleeding (HMB). Over 80% of women with VWD experience HMB resulting in morbidity from decreased quality of life, lost productivity, and iron deficiency. Hormonal birth control is a standard treatment and can elevate VW activity (RCo/GPB1M) and antigen (Ag) levels. Little is known about the impact of such therapy on bleeding assessment tools (BATs). We hypothesized that women on hormonal therapy (HT) would have lower ISTH-BAT scores and higher VWD levels than those not on HT. Women who participated in the Zimmerman Program (PPG) for the Molecular and Clinical Biology of VWD, a natural history study (NHLBI HL081588), had demographic, medication history, and laboratory samples collected. We sought to identify differences in patient, disease-specific factors, and BATs between type 1 VWD women on HT and those not on HT. Methods: Women with type 1 VWD and reported menstrual history were selected from the PPG. Women were split into those taking HT (OCPs, injectable progestins, hormone replacement therapy, intravaginal devices, and IUDs) vs. those who were not. Women >50 years of age were excluded from the group analysis due to their assumed postmenopausal status. Descriptive statistics were calculated to characterize the demographics, VWD testing (VWF:Ag, VWF:RCo, GPIbM), and ISTH-BATs (total, HBM, and PPH) of the two groups. Continuous variables were compared between groups using two sample t-test and categorical variables by Fischer's exact test. A two-sided p-value of< 0.05 was considered statistically significant. Results: In the full cohort, 269 women answered yes to experiencing menstrual cycles. The group was predominantly pediatric/young adult with a mean age of 25.3 years (range 11-76). Whites comprise 86% of subjects. Women were further defined by disease laboratory testing with 186 women (69.1%) diagnosed as VWF:Ag 0.3-0.5 IU/mL, 57 women (21.2%) VWF:Ag <0.3 IU/mL, and 26 women (9.7%) clearance type VWD (genetic result). The mean VWF:Ag for the entire cohort was 0.37 IU/mL (Standard Deviation 0.14 IU/mL). The mean VWF: RCo was 0.36 IU/mL (SD 0.15 IU/mL). The ISTH-BAT scores ranged from 0-29, with a mean of 7.6 (SD 5.1). An evaluation of the HMB domain of the ISTH-BAT demonstrated that 94% (253) of women reported HMB with >1 point (on a 4-point scale) overall, 47% (119) of whom reported severe HMB with 3 or 4 points. Of the 269 women, 108 were taking HT at enrollment. The types of HT included OCPs (71), medroxyprogesterone acetate (11), levonorgestrel IUD (11), contraceptive implant (3), and etonogestrel/ethinyl estradiol vaginal ring (1). After excluding women with presumed postmenopausal status, we identified 105 women on hormonal therapy and 143 who were not. Graph 1 provides an overlay of the ISTH-BAT scores by hormone treatment status. Table 1 demonstrates the demographic and disease features of the two groups. On average, women on HT were younger, 20.7 years vs. 24.5 years (p= 0.003), than those who were not. Other disease characteristics, including disease subtype, VWF laboratories (VWF:Ag, VWF: RCOF, VWF GPIbM), and ISTH-BAT HMB and PPH specific domains were not significantly different between the groups. Higher total ISTH-BAT scores were observed for women not on HT (7.4± 5.1) compared to those who were (6.8± 4.2); however, the difference was not statistically significant. Conclusions: For women with type 1 VWD, HMB is widespread, affecting 94% of the subjects enrolled in the PPG. Hormone therapy was common, with 47% receiving treatment. Apart from age, there were no significant differences in the disease characteristics or BATs between women with type 1 VWD who are and are not receiving hormone therapy in this cohort. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Relationship between the Amount of Menstrual Flow and Cardiac Status in Women with Fontan Circulation.

A high prevalence of heavy menstrual bleeding (HMB) has been reported in women with Fontan circulation. Cyanosis has been reported to contribute to HMB, and menstruation has been suggested to affect cardiac status in women with congenital heart disease. This study aimed to evaluate the relationship between the amount of menstrual flow and cardiac status in women with Fontan circulation.Twenty women who had undergone the Fontan procedure were prospectively investigated and the amount of their menstrual flow was evaluated using a questionnaire. Participants were divided into two groups-small and large menstrual bleeding groups-and their clinical data, including the results of hematological tests and echocardiographic findings, were evaluated.One (5%) woman showed primary amenorrhea. Eight of the remaining 19 (42%) women were included in the large menstrual bleeding group. Women with large menstrual bleeding showed a significantly higher hematocrit level (47.1% [36.2%-50.3%] versus 42.1% [35.3%-44.9%], P = 0.006) and longer QRS duration (106 [92-172] ms versus 88 [78-140] ms, P = 0.008), as well as a lower fractional area change (37.4% [35.6%-47.2%] versus 47.0% [38.2%-55.7%], P = 0.010) and global longitudinal strain (-10.5% [-14.9% to -6.6%] versus -13.9% [-20.5% to -7.8%], P = 0.041) of the dominant ventricle on echocardiography, than women with small bleeding.Erythrocytosis, longer QRS duration, and reduced ventricular function were related to increased menstrual bleeding in women with Fontan circulation. These functions may be interrelated with the amount of menstrual flow in such women.

Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders.

There has been limited studies examining treatment-induced heavy menstrual bleeding (HMB) in women with severe mental illnesses. The aim of this study was to examine HMB prevalence and HMB-associated factors in young women (18–34 years old) diagnosed with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia (SCZ) who have full insight and normal intelligence. Eighteen-month menstruation histories were recorded with pictorial blood loss assessment chart assessments of HMB. Multivariate analyses were conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Drug effects on cognition were assessed with the MATRICS Consensus Cognitive Battery (MCCB). HMB prevalence were: BP, 25.85%; MDD, 18.78%; and SCH, 13.7%. High glycosylated hemoglobin (HbA1c) level was a strong risk factor for HMB [BP OR, 19.39 (16.60–23.01); MDD OR, 2.69 (4.59–13.78); and SCZ OR, 9.59 (6.14–12.43)]. Additional risk factors included fasting blood sugar, 2-h postprandial blood glucose, and use of the medication valproate [BP: OR, 16.00 (95%CI 12.74–20.22); MDD: OR, 13.88 (95%CI 11.24–17.03); and SCZ OR, 11.35 (95%CI 8.84–19.20)]. Antipsychotic, antidepressant, and electroconvulsive therapy use were minor risk factors. Pharmacotherapy-induced visual learning impairment was associated with HMB [BP: OR, 9.01 (95%CI 3.15–13.44); MDD: OR, 5.99 (95%CI 3.11–9.00); and SCZ: OR, 7.09 (95%CI 2.99–9.20)]. Lithium emerged as a protective factor against HMB [BP: OR, 0.22 (95%CI 0.14–0.40); MDD: OR, 0.30 (95%CI 0.20–0.62); and SCZ: OR, 0.65 (95%CI 0.33–0.90)]. In SCZ patients, hyperlipidemia and high total cholesterol were HMB-associated factors (ORs, 1.87–2.22). Psychiatrist awareness of HMB risk is concerningly low (12/257, 2.28%). In conclusion, prescription of VPA should be cautioned for women with mental illness, especially BP, and lithium may be protective against HMB.

Reduced Activity and Quality of Life in Women Soldiers with Heavy Menstrual Bleeding and Dysmenorrhea.

The aim of the study was to examine the effect of heavy menstrual bleeding (HMB) and dysmenorrhea on daily activity and quality of life (QoL) in young women engaged in demanding activities. Cross-sectional study. A total of 422 Israeli women soldiers in combat and non-combat roles. Participants were asked to provide consent and to complete study questionnaires. A pictorial bleeding assessment chart (PBAC), visual analog scale (VAS), verbal multidimensional scoring system for assessment of dysmenorrhea, and approved Hebrew-translated age-appropriate Pediatric Quality of Life Inventory (PedsQL). HMB (PBAC >100) and severe HMB (PBAC >185) were demonstrated in 181 (50%) and 96 (26%) participants, respectively. A high PBAC score was recorded in 20% who answered "no" or "unknown" in the questionnaire on having HMB. Mild, moderate, and severe dysmenorrhea were demonstrated in 80 (21.5%), 115 (31%), and 142 (38%) participants, respectively. The prevalence of HMB and dysmenorrhea was similar in soldiers in combat and non-combat roles. Diagnosis of HMB was related to the lower fitness-for-service score, history of bleeding, and dysmenorrhea. Daily activity and QoL were both affected by the severity of HMB and dysmenorrhea. Underdiagnosis of HMB and dysmenorrhea results from a combination of unawareness from the women's side and inattention from the system. In an era of female empowerment, each woman should be at the optimal physiological and psychological level to start her career; thus, addressing the menstrual burden and providing effective treatment is needed in the military scenario and other settings with demanding activities.

Эффективность и безопасность комбинированного контрацептива с хлормадинона ацетатом при обильных менструальных кровотечениях и дисменорее в реальной клинической практике

This article presents the results of the prospective study involving 70 patients of reproductive age with heavy menstrual bleeding (HMB) and dysmenorrhea, interested in reliable contraception. Objective. To study the safety and efficacy of the low-dose combined oral contraceptive (COC) containing chlormadinone acetate (CMA) for the treatment of dysmenorrhea and HMB in real clinical practice. Patients and methods. Among 90 women who sought a method of contraception, we identified a group of 70 patients aged 18–45 years (mean age = 31.0 ± 7.7 [95% CI 29.2–32.9]) with complaints for HMB (n = 23) and/or dysmenorrhea (n = 65): primary (n = 37) and secondary (n = 28). For contraception, COC containing 0.03 mg ethinyl estradiol and 2 mg CMA was recommended. After 3 months, the dynamics of the volume of menstrual blood loss, pain severity (according to the Numeric Rating Scale (NRS)), as well as the frequency of side effects were assessed. Results. Among 90 women of reproductive age, 70 (78%) had HMB and/or dysmenorrhea of varying severity. After 3 months of using a low-dose CMA-containing COC, 87% of patients with HMB showed a statistically significant decrease in menstrual blood loss (p &lt; 0.001); in 72% of patients, a significant decrease in pain severity was observed: mean NRS value before taking COC was 6.2 ± 2.1 [95% CI 5.7–6.7]), it decreased to 3.5 ± 1.8 [95% CI 3.0-3.9]) (p &lt; 0.001) after 3 months. There were no significant differences in efficacy between the groups with primary and secondary dysmenorrhea. Conclusion. The prevalence of HMB and dysmenorrhea in a random sample of women of reproductive age is consistent with the data of systematic reviews (26% and 72%, respectively). The results obtained in real clinical practice confirm the additional therapeutic efficacy of the low-dose CMA-containing COC in HMB and dysmenorrhea. The frequency and severity of side effects during the COC use do not depend on the initial body mass index, but with an increase in the waist-to-hip ratio, there is a tendency to reduce the chance of developing side effects of using COC, which corresponds to the data on the metabolic neutrality of chlormadinone. Key words: chlormadinone, heavy menstrual bleeding, dysmenorrhea

Key issues in the management of adolescents and young women with heavy menstrual bleeding

Despite high prevalence of heavy menstrual bleeding (HMB) in adolescents and young women, most recommendations are not specific for this population, which makes the diagnosis and management challenging. Gynecologists should be able to establish underlying causes of HMB, which most common are nonstructural in adolescents, and the severity of bleeding, to provide early diagnosis, using appropriate therapy for improving quality of life and iron deficiency prevention. First line management consists of hormonal therapy approved for HMB treatment, capable to normalize menstrual blood loss and iron metabolism parameters.

Prospective associations between physical activity and BMI with irregular periods and heavy menstrual bleeding in a large cohort of Australian women.

Are physical activity (PA) and body mass index (BMI) associated with irregular periods and heavy menstrual bleeding (HMB) in Australian women? Overweight and obese women have higher odds of both irregular periods and HMB than underweight/normal-weight women, but high levels of PA reduce the odds of HMB. Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies. Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women's Health (ALSWH) who completed mailed surveys in 1996, with follow-ups in 2000, 2003, 2006, 2009, 2012, and 2015. Participants were aged 22 to 27 in 2000. They were asked to report their PA levels and the frequency of irregular periods and HMB in each survey. BMI was calculated at every survey from self-reported weight and height. Generalised estimating equation population-averaged model analyses were conducted to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). At age 22 to 27 years, the prevalence of irregular periods was 19.4%. This remained stable over 15 years. There were no associations between PA and irregular periods. Overweight and obese women had higher odds of irregular periods [overweight: OR 1.08, (95% CI 1.00-1.17); obese: OR 1.29, (95%CI 1.18-1.41)] than women who were underweight/normal weight.The prevalence of HMB at age 22-27 years was 15.9%; this doubled over 15 years. Women who were highly active had 10% lower odds of HMB than women who reported no PA [OR 0.90, (95%CI 0.82-0.98)]. Overweight and obese women had higher odds of HMB [overweight: OR 1.15, (95%CI 1.07-1.23); obese: OR 1.37, (95%CI 1.26-1.49)] than women who were underweight/normal weight. Among obese women, high levels of PA were associated with 19% [OR 0.81, (95%CI 0.68-0.97)] reduction in the odds of HMB. Data collected in the ALSWH are self-reported, which may be subject to recall bias. Reverse causation, due to menstrual problems impacting PA, is possible although sensitivity analyses suggest this is unlikely to have affected the results. Other conditions, e.g., polycystic ovary syndrome, for which no or incomplete data were available, could have affected the results. Intervention studies are needed to assess the effect of increasing PA in women with HMB, but these preliminary findings suggest that promoting PA could be an affordable and feasible strategy for reducing HMB in young adult women. The ALSWH is funded by the Australian Government. Funding for these analyses was provided by a University of Queensland (UQ) International Postgraduate Research Scholarship and a UQ International Development Fellowship. The authors declare no conflicts of interest. N/A.

Assessment of Behavior of Women during Abnormal Menstrual Bleeding and Its Effect: An Observational Study

Background: Up to 30% of women suffer from heavy menstrual bleeding (HMB) at some point in their lives. Despite the high prevalence of HMB, many women lack a fundamental understanding of the disorder and often present to the emergency department seeking treatment rather than obtaining preventive care in outpatient health clinics. Hence; we planned the present study to assess behavior of women during abnormal menstrual bleeding. Methods: A total of 50 subjects with abnormal bleeding and 50 subjects with normal menstrual bleeding were included in the present study. A self-framed questionnaire was prepared and was given to all the subjects. Complete demographic data of all the patients was obtained. The questionnaire covered the topics for covering the behavioral aspect of women during abnormal menstrual bleeding and it effect. Results: ‘Significant results were obtained while comparing the behavior changes among the subjects of the normal bleeding group and of abnormal bleeding group. It was observed that abnormal bleeding had significant negative impact on the quality of life. It often resulted in significant limitation of work, avoidance of social activities, avoidance of travel and feeling of physical weakness. Conclusion: Abnormal bleeding pattern significantly affects the quality of life of women. Therefore, adequate awareness programs should be initiated by community health centers for increasing the awareness of general population about abnormal bleeding and its consequences.

The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age.

Objectives:To investigate the prevalence and impacts of heavy menstrual bleeding (HMB) on anemia, fatigue, and the quality of life (QoL) in women of reproductive age.Methods:This study was conducted among 306 women of reproductive age who presented at the internal medicine outpatient departments of the training and research hospital of a university. The data of the study were collected by the “Data collection form”, “SF-36 Quality of Life Scale (SF-36 QoLS)” and “Brief Fatigue Inventory (BFI)”.Results:The prevalence of HMB in women of reproductive age was 37.9%. The ferritin level and physical functions were found to decrease significantly as the duration of menstruation increased (p<0.05). Besides, a positive but very weak relationship was found between the menstruation duration and the subdimensions of the global BFI and the general health perception subscale of the SF-36 QoLS (p<0.05).Conclusion:It was determined that HMB is common and has negative effects on anemia, fatigue and some subdimensions of the QoL. Regular screening for HMB that may not be expressed by many women may therefore be useful in preventing and resolving the health problems that it will cause.

Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey

ObjectiveTo examine the prevalence and impact of heavy menstrual bleeding (HMB) among women in Europe, and their experience of HMB assessment and management. MethodsAn internet-based survey was conducted among women (aged 18–57years) in five European countries between January and February 2012. The prevalence of HMB among the general population was determined in a short survey, and women who had been diagnosed with HMB were then asked to complete an extended survey about their diagnosis and symptoms. ResultsOverall, 4506 women responded, of whom 1225 (27.2%) had experienced two or more predefined HMB symptoms within the previous year. Of these women, 564 (46.0%) had never consulted a physician. Among 330 women who completed the detailed survey, 208 (63.0%) had ever been diagnosed with iron deficiency or iron-deficiency anemia. Symptoms associated with iron deficiency were used to help confirm a diagnosis in 83 (39.9%) women. Only 152 (46.1%) of the 330 patients with confirmed HMB had received prescription medication for iron deficiency. ConclusionMany women affected by HMB do not seek medical help, and few of those who do consult physicians report that they have received appropriate treatment. HMB continues to be underdiagnosed and poorly treated.

Case Report : Hermansky Pudlak Syndrome (Presenting as late onset heavy Menstrual Bleeding)

Inherited bleeding disorders contribute significantly to the incidence and prevalence of Heavy Menstrual Bleeding (HMB), and contrary to popular belief can present any time during the reproductive years of a woman's life. The following case exemplifies this and is being presented as part of a rare syndrome. The incidence of this syndrome in the general population ranges from 1:500,000 to 1:1000, 000. Besides being rare the presentation was quite uncommon as majority of these cases present with pulmonary fibrosis.