Treatment Of Dysfunctional Uterine Bleeding Research Articles

Transarterial embolization of uterine arteries in emerging dysfunctional uterine bleeding: a single-center case series study

BackgroundUterine artery embolization is proven to be an effective treatment for symptomatic uterine fibroids. Yet, its role in the management of dysfunctional uterine bleeding is still debatable. Patients with dysfunctional uterine bleeding have abnormal bleeding from the uterine vascular bed with variable underlying mechanisms. Uterine artery embolization will reduce/prevent bleeding by occlusion of the vascular bed, with subsequent cutoff of the effect of hormones on the endometrium. The aim of this work is to demonstrate the safety, efficacy and possible short-term complications of uterine artery embolization in the treatment of dysfunctional uterine bleeding (DUB) as a first-line treatment modality rather than the current treatment options (hormonal and surgical treatment).MethodsThirty patients included in the study were clinically and laboratory diagnosed based on FIGO classification system (PALM-COEIN) as DUB, and the diagnosis was confirmed by MRI imaging. All patients were subjected to transcatheter uterine artery embolization with subsequent clinical and radiological follow-up to assess the treatment outcome.ResultsUterine artery embolization was able to control bleeding in patients diagnosed as DUB, with subsequent complete cessation of medical treatment; no surgical interference was needed with much less morbidity. We had 93.3% improvement in the frequency, volume of bleeding and 100% improvement of the presenting anemia. No significant change in uterine volume or in endometrial thickness has been noted.ConclusionsUterine artery embolization is safe, effective procedure to control dysfunctional uterine bleeding with the preservation of the uterus especially in critical age groups.

Key to Life: Physiological Role and Clinical Implications of Progesterone.

The most recent studies of progesterone research provide remarkable insights into the physiological role and clinical importance of this hormone. Although the name progesterone itself means “promoting gestation”, this steroid hormone is far more than a gestational agent. Progesterone is recognized as a key physiological component of not only the menstrual cycle and pregnancy but also as an essential steroidogenic precursor of other gonadal and non-gonadal hormones such as aldosterone, cortisol, estradiol, and testosterone. Based on current findings, progesterone and novel progesterone-based drugs have many important functions, including contraception, treatment of dysfunctional uterine bleeding, immune response, and prevention of cancer. Considering the above, reproduction and life are not possible without progesterone; thus, a better understanding of this essential molecule could enable safe and effective use of this hormone in many clinical conditions.

Comparison of the Levonorgestrel-releasing intrauterine system and oral tranexamic acid in the treatment of dysfunctional uterine bleeding

Materials and Method: 60 patients who were diagnosed with DUB and were treated with either oral tranexamic acid 3gr/day or LNG-IUS were included in the study. Bleeding scores(PBAS), duration of bleeding and haemoglobin values before the therapy were recorded. Patients were evaluated again for the same parameters and possible side effects on the 3rd and 6th months of therapy. Results: Decrease in duration of bleeding on the 3rd and 6th months of therapy were statistically significant in both groups(p<0,05). While there was no statistically significant difference on the decrease in the duration of bleeding on the 3rd month of therapy(p>0,05), the decrease was more significant in the LNG-IUS group than the tranexamic acid group on the 6th month(p<0,05). In the tranexamic acid group, PBAS dropped by 55 % on the 3rd month, and 62% on the 6th month, but these changes were not significantly different from each other(p>0,05). In the LNG-IUS group, PBAS decreased by 87.5 % on the 3rd month, and 90.5% on the 6th month, and these changes were statistically significant(p<0,05). However, the decrease in the amount of bleeding was significantly more in the LNG-IUS group than the tranexamic acid group(p<0,05). While haemoglobin levels increased 5.6% on the 3rd month and 9.4% on the 6th month in the LNG-IUS group, they increased 3.6% on the 3rd month and 4.5% on the 6th month in the tranexamic acid group. In the LNG-IUS group the most common complaint was mastalgia on the 3rd month of therapy(40%, 10 patients), and oligomenorrhea-amenorrhea on the 6th month (43%, 10 patients). After 6 months, 78% of patients continued the treatment, while 2 patients(6.6%) quit the therapy because of the side effects. In the tranexamic acid group, the compliance rate was 63%, and none of the patients had discontinued the therapy due to side effects. Conclusion: Even though LNG-IUD is more effective than tranexamic acid in reducing blood loss in DUB patients, the major change in the menstrual cycle pattern and systemic side effects are the most common reasons for discontinuing therapy. Tranexamic acid reduces blood loss while conserving cycle patterns and fertility, and is better tolerated.

Comparative Study of Desogestrel- Containing Oral Contraceptive and Levonorgestrel- Containing Oral Contraceptive in Dysfunctional Uterine Bleeding

Dysfunctional uterine bleeding is a type of abnormal uterine bleeding where vaginal bleeding occurs outside of the menstrual cycle in the absence of any known pelvic pathology. Dysfunctional uterine bleeding can be treated safely with hormone therapy. Combined oral contraceptives help in increased menstrual cycle regularity and decreased blood loss. In this study, a reliable drug for the dysfunctional uterine bleeding with maximum effectiveness and minimal side effects were assessed. This study was conducted on 120 cases of dysfunctional uterine bleeding. Patients who were diagnosed with dysfunctional uterine bleeding were randomly assigned into two groups. Group D and group L included patients who were given Ethinyl estradiol 0.02mg + desogestrel 0.15mg and Ethinyl estradiol 0.03mg + levonorgestrel 0.15mg respectively for the four consecutive 28- day cycles. Menstrual blood loss was assessed using the pictorial blood assessment chart (PBAC) score on 2nd and 4th months of recruitment. Side effects such as weight gain, acne and headache were assessed in both groups. This study shows 56.68% reduction in mean PBAC score in 2 months in desogestrel group whereas only 44.96% reduction in levonorgestrel group and 79.87% reduction in mean PBAC score in desogestrel group in 4 months whereas only 74.46% reduction in levonorgestrel group. Side effects like weight gain, acne and headache were more prominent in the levonorgestrel group than desogestrel group. Desogestrel containing combined oral contraceptive can be a useful and safe treatment for dysfunctional uterine bleeding.

Network Pharmacology-Based Prediction of Active Ingredients and Potential Targets of ShengDiHuang Decoction for Treatment of Dysfunctional Uterine Bleeding.

Objective To analyze the potential active ingredients and related crucial targets of the ShengDiHuang Decoction (SDHD) formula in the treatment of dysfunctional uterine bleeding (DUB) by using network pharmacology and verification experiment. Methods In this study, we determined the potential active ingredients from the traditional SDHD formula and their targets with the network pharmacology method. The network of “compound-disease-target” was constructed by the software of Cytoscape. Software of DAVID was used to enrich pathways for these 87 targets of SDHD. Further, the therapeutic effect of SDHD on DUB was verified by observing the morphological changes of the uterus and ovaries and determining the expression of ERS2 and progesterone in the plasma. Results 52 compounds of Rheum and 5 compounds of Rehmannia were selected, and 87 potential targets were screened by network pharmacology. Furthermore, 7 main active ingredients were acquired by the ADME process. In addition, enrichment analysis of drug-target networks indicated that SDHD may play a role in overall coordination through “multicomponent and multitarget” in different organ patterns by regulating multiple pathways directly or indirectly. Finally, in the verification experiment of SDHD on DUB, it was found that SDHD can effectively repair the uterus and ovaries and also have an upregulation effect on the target ESR2 and increase the content of progesterone. Conclusion Overall, this study revealed potential mechanisms of multitarget and multicomponent about SDHD in the treatment of DUB and provided a scientific foundation for further studying the mechanism.

功能失调性子宫出血的治疗进展

功能失调性子宫出血的治疗进展

A comparative study of norethisterone and combined oral contraceptive pill in the treatment of dysfunctional uterine bleeding

Background: A significant percentage of women in India suffer from dysfunctional uterine bleeding (DUB), which has a negative impact on physical and social life. Norethisterone and low-dose combined oral contraceptive (COC) pills are used in the treatment of DUB. Aim: The aim of this study was to compare the efficacy and safety of norethisterone and low-dose COC pills in reduction of blood loss in DUB. Materials and Methods: A prospective randomized interventional study was conducted with patients with DUB. Pretreatment pictorial blood loss assessment chart (PBAC) and hemoglobin in blood were obtained from patients. Then, Group I (n = 50) and Group II (n = 50) patients were provided treatment with norethisterone and low-dose COC pills, respectively. Posttreatment PBAC and hemoglobin level in blood was obtained after 6 months of treatment. Improvements in PBAC and hemoglobin level (difference between posttest and pretest value) were compared by unpaired t-test with α = 0.05. Results: Mean age of Group I and Group II patients was 28.62 ± 9.84 and 28.42 ± 10.08 years, respectively. Improvement in PBAC score in patients treated with norethisterone versus low-dose COC pill was −98.62 ± 7.82 versus −96.44 ± 8.74 (P = 0.19). Improvement in hemoglobin level in patients treated with norethisterone versus low-dose COC pill was 2.75 ± 1.06 gm/dL versus 2.71 ± 0.86 gm/dL (P = 0.84). Conclusion: Norethisterone and low-dose COC pills were found to be equally efficacious in reducing bleeding in DUB. Hence, any one of the drugs can be used in the treatment of DUB according to patients' profile. However, considering the side effects, low-dose COC pills may be a better choice.

Uterine adenosarcoma in a patient following microwave endometrial ablation: a case report

In Japan, almost six million women are said to be suffering from menorrhagia. Microwave endometrial ablation (MEA) is a minimally invasive and effective surgical treatment for dysfunctional uterine bleeding using the application of microwave energy to the endometrium. Its popularity has been increasing over time in many countries because of its safety and simplicity. Recently, a number of cases of medical complications after MEA have been reported. Here, the authors present the first reported case of adenosarcoma diagnosed in a woman, five years after treatment with MEA. This finding highlights the need for gynecologists to use caution and perform close patient follow-up for a prolonged time period after MEA.

Clinical effect of Ejiao Huangqi oral liquid combined with norethisterone in treatment of dysfunctional uterine bleeding and its effect on improving anemia

Objective To observe the clinical effect of Ejiao Huangqi oral liquid combined with norethisterone in treating dysfunctional uterine bleeding and its effect on improving anemia. Methods 100 patients with dysfunctional uterine bleeding were randomly divided into study group(50 cases) and control group(50 cases) according to the order of admission.The control group was given oral norethindrone treatment, the study group was given Ejiao Huangqi oral liquid on the basis of the control group, 10mL per time, 2 times a day.Both two groups were treated for 3 menstrual cycles.The fasting blood samples were taken to test the red blood cells(RBC) and hemoglobin(Hb). All patients were followed up for 3 months to evaluate clinical efficacy. Results The levels of RBC and Hb in the study group and control group were (3.05±0.58)×1012/L and (3.67±0.65)×1012/L, (86.75±6.30)g/L and (97.95±6.53)g/L, respectively, which were significantly higher than those before treatment(all P<0.05). The levels of RBC and Hb in the study group were significantly higher than those in the control group(P<0.05). The total effective rate of the study group was 92%(46/50), which was significantly higher than that of the control group[84%(42/50)], the difference was statistically significant(Z=-3.334, P<0.01). Conclusion Ejiao Huangqi oral liquid combined with norethisterone has exact effect in treating dysfunctional uterine bleeding, can quickly stop bleeding, improve the symptoms of anemia, improve the clinical treatment effect, which is worthy of clinical use. Key words: Uterine hemorrhage; Ejiao huangqi oral liquid; Norethindrone; Anemia

Systematic Review of Chinese Medicine for the Treatment of Dysfunctional Uterine Bleeding

Objectives: To evaluate the effectiveness of Chinese medicine in treating dysfunctional uterine bleeding via a systematic review and meta-analysis. Methods: Clinical trials of Chinese medicine treating dysfunctional uterine bleeding were retrieved with specific search strategy in the following databases: CNKI (from 1994 to December 2016), Wan Fang (from 1980 to December 2016), Pro Quest Medical Database (from 1980 to December 2016), MEDLINE (from 1950 to December 2016) and PUBMED (from 1980 to December 2016). Eligible randomized controlled trials (RCTS) were selected with the inclusion and exclusion criteria. The quality of trials was accessed by the risk of bias assessment tool. Data was extracted into Excel and analyzed by Software Rev Man 5.3. Result: A total of 21 RCTs were included with 2167 patients. The meta-analysis showed that the Chinese medicine group had higher recovery rate than that of the Western medicine group [OR=2.26, 95% CI (1.86, 2.74), P&lt;0.00001]. The effectiveness of Chinese medicine was superior to the Western medicine [OR=3.93, 95% CI (2.99, 5.169), P&lt;0.00001]. There were no significant difference in bleeding arrest in 3 days [OR=0.90, 95% CI (0.49, 1.63), P=0.73] and in 10 days [OR=1.40, 95% CI (0.80, 2.44), P=0.24] between Chinese medicine group and Western medicine group. Few side effects were observed in the Chinese medicine group [OR=0.04, 95% CI (0.01, 0.11), P&lt;0.0001]. The Chinese medicine group also had a lower recurrence rate than that of Western medicine group [OR=0.16, 95% CI (0.06, 0.47), P=0.0008]. Conclusion: Chinese medicine appears to have better overall clinical effect in treating dysfunctional uterine bleeding with less side effects and lower chance of recurrence. However, the quality of the included studies needs to be improved; the findings should be interpreted with caution. Further large-scale, rigorously designed trials are warranted to confirm the findings.

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.

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.

Novasure impedance control system versus microwave endometrial ablation for the treatment of dysfunctional uterine bleeding: a double-blind, randomized controlled trial

To compare the efficacy and safety of two different second-generation ablation devices, Novasure impedance control system and microwave endometrial ablation (MEA), in cases of abnormal uterine bleeding (AUB).This is a randomized controlled trial that took place in a single Gynecological Department of a University Hospital. Sixty-six women with dysfunctional uterine bleeding (DUB), unresponsive to medical treatment, were included in the trial. The ratio of women allocated to bipolar radio-frequency ablation or MEA was 1:1. Follow-up assessments were carried out at three and 12 months post-ablation. The present main outcome measure was amenorrhea rates 12-months post-treatment.The rate of amenorrhea at 12-months post-ablation was significantly higher in women treated by Novasure (25/33; 75.8%) as compared to those treated by MEA (8/33; 24.2%) (rate difference: +51.5%, 95% CI: +27.8 to +67.7).In women with DUB, endometrial ablation with Novasure bipolar radiofrequency impedance-controlled system is associated with increased rates of amenorrhea at 12-months post-treatment as compared to the MEA method.

Endometrial thickness by USG as a guideline for the treatment of Dysfunctional uterine bleeding in Premenopausal Women

Introduction: Endometrium is mucosal layer of uterus. Throughout the reproductive age, endometrium undergoes cyclical changes during each lunar month to prepare uterus for implantation. Dysfunctional uterine bleeding (DUB) is the most common cause of abnormal vaginal bleeding (AUB) during a womans reproductive years. It affects womens health both medically and socially. Aim & Objective: To decide cut of limit of Endometrial thickness (ET) by ultrasonography (USG) for the treatment of DUB patients in premenopausal women. Method: A total of 60 patients with irregular menstrual bleeding of DUB attending Department of Obstetric and Gynecology in M G M Medical College and Hospital were selected. ET was noted by USG. Result: In younger age group most of patients showed good response to medical line of treatment, while premenopausal women needed surgical line of treatment. Conclusion: ET in younger age group is in the normal range ( 8 mm.

Becoming a competent doctor: ongoing responsibilities

The author reflects on the experience surrounding his critical appraisal of DeVore GR, Owens O, Kase N. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding--a double-blind randomized control study. Obstet Gynecol. 1982 Mar;59(3):285-91.

Intravenous estrogen is not proven effective for abnormal uterine bleeding: guidelines are based on flawed evidence

A clinical appraisal and clinical application of: DeVore GR, Owens O, Kase N. treatment of dysfunctional uterine bleeding-- a double This appraisal identifies significant statistical irregularities in the study. A reworking of the study's statistics lea different from that put forth by the authors of this paper: intravenous estrogen therapy is not, in fact, significantly more compared to placebo therapy for the cessation of acute abnormal uterine bleeding.

Thermal balloon ablation versus transcervical endometrial resection: evaluation of postoperative pelvic pain in women treated for dysfunctional uterine bleeding

Purpose of the study: To evaluate postoperative pain after mini-invasive surgical treatment for dysfunctional uterine bleeding (DUB) with transcervical endometrial resection or thermal ablation balloon. Materials and Methods: A longitudinal observational study, analyzing 47 women affected by DUB who underwent endometrial ablation was conducted. The authors collected evaluation of pelvic pain at one and four hours after intervention and the individual necessity of analgesics. After 30 days, all patients underwent a gynecological visit to evaluate postoperative outcome. Results: Pelvic pain was higher one and four hours after procedure in thermal balloon ablation group, and patients in the same group required more analgesic rescue dose. There were no complications such as uterine perforation, heavy blood loss or thermal injuries with both the procedures. Conclusion: Thermal balloon ablation appears a more painful procedure than endometrial resection, both in the immediate postsurgical time and 30 days after surgery. Ad hoc anaesthesiologic and analgesic protocol should be adopted to ensure quick recovery and good acceptance of the procedure.

A double blinded randomized controlled trial to compare Ormeloxifene and Norethisterone in the treatment of Dysfunctional Uterine Bleeding

Aims: To compare the safety and efficacy of ormeloxifene and norethisterone in treatment of dysfunctional uterine bleeding as measured by decrease in menstrual blood loss using pictorial blood assessment chart. To assess the percentage change in haemoglobin and endometrial thickness before and after treatment. To assess the subjective improvement in life style as evaluated by a five point Likert scale. Methods: A double blinded randomized control trial was conducted on patients attending gynaecology OPD with complaints of menorrhagia with following inclusion criteria women between 18 and 51 years of age, absence of coagulopathies and any pelvic pathology, not taking any drug affecting menstruation, no hormonal therapy in previous three months and normal renal function. Findings and Interpretation: The menstrual blood loss was observed to decrease by 19.31% at end of two months, 30.74% at the end of four months and 43.25% at end of six months in case of norethisterone and 20.72% at the end of two months, 43.37% at end of four months and 59.50% at the end of six months in case of Ormeloxifene. There was an increase in haemoglobin percentage in both the groups and it was significantly better in case of Ormeloxifene. PBAC score and endometrial thickness improvement was better in case of ormeloxifene compared to norethisterone. The side effects were similar in both the cases except for follicular cyst which was seen in Ormeloxifene group. I. Introduction A woman can expect roughly 400 menstrual cycles during her reproductive lifespan, and it is estimated that up to 20% of women will have excessive menstrual blood loss. Although age of menopause has remained the same over this century, the magnitude of menstrual disorders has increased, likely because of shortened breast-feeding intervals, fewer pregnancies per woman, higher frequency of permanent sterilization, and later age of conception. Dysfunctional uterine bleeding is a diagnosis of exclusion when organic, systemic and pelvic pathology all have been ruled out. Once a diagnosis has been reached with the aid of history, examination, haematological and endocrine investigations, and dilatation and curettage when appropriate, medical treatment is the usual first line approach. The treatment options for dysfunctional uterine bleeding are diverse, which can be finally tailored to cater the needs of patients of different socioeconomic background, different age groups and different reproductive needs. Treatment options range from offering medical measures such as cyclooxygenase inhibitors, tranexamic acid, hormonal agents and in cases not managed by medical therapy offering surgical management. Trials comparing the various modalities have flooded the literature but ambiguity still exists. Norethisterone is still the most frequently prescribed drug for dysfunctional uterine bleeding serving 38% of the patient population the reason being cost effectiveness and absence of side effects. Ormeloxifene (also known as centchroman) is one of the selective estrogen receptor modulators used primarily as a contraceptive, but it is also effective in dysfunctional uterine bleeding. We undertook the study to compare the safety and efficacy of the two drugs in dysfunctional uterine bleeding.

Comparative study of low-dose oral contraceptive pill and ormeloxifene in the treatment of dysfunctional uterine bleeding

Background: Role of oral contraceptive pill (OCP) and ormeloxifene (ORM) in dysfunctional uterine bleeding (DUB) is still in an exploring level. Aim: The aim was to observe the improvement of the menstrual bleeding pattern in terms of the amount, regularity, and hemoglobin (Hb) status of the women. Setting: Study was conducted in the Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital, Kolkata a tertiary care teaching hospital. Design: Prospective randomized study with patients having subjective complaints of menorrhagia. Materials and Methods: A total of 36 women was treated with ORM 60 mg and OCP containing 30 μg ethinyl estradiol and 150 μg desogestrel was given to 34 women. Pictorial blood loss assessment chart (PBAC) was applied to assess the amount of bleeding. Statistical Analysis Used: Data were compared using a t-test (paired and unpaired) and Mann-Whitney U-test for numerical variables and McNemar's Chi-square test for categorical variables. Results: The primary outcome showed a comparable PBAC score of ORM in first posttreatment cycle and significantly better in following two cycles (PBAC - postC1: 0.118, PBAC - postC2: 0.016, and PBAC - postC3: 0.04). Group receiving OCP was observed to have good cycle regularity in comparison to ORM (P = 0.006). Hb rise in both groups was almost similar, OCP group revealed an improvement in mean Hb concentration of 0.65 g%, whereas ORM showed a rise of 0.72 g%. Secondary outcomes were adverse reactions, satisfaction level, and poor responders in both groups. Conclusion: ORM is effective in treating DUB in almost in all aspects and can be considered as nonsteroidal option of therapy.

Dysfunction of the Clinical Effect of Levonorgestrel Treatment of Dysfunctional Uterine Bleeding

&lt;strong&gt;Objective: &lt;/strong&gt;Study clinical curative effect of levonorgestrel treatment on perimenopausal dysfunctional uterine bleeding. Method: Selected 126 outpatient of dysfunctional uterine bleeding which hospitalize from December 2010 to December 2012 at department of gynaecology to undergo levonorgestrel treatment on the 5‒7 days of menstruation. The endometrial thickness, hemoglobin, and the PBAC score of before and 3, 6, and 12 months after placement were observed and recorded. To observation the adverse reactions after levonorgestrel treatment. &lt;strong&gt;Results: &lt;/strong&gt;After treatment, the thickness of the endometrium, the amount of menstruation and the hemoglobin concentration increased in 126 patients. During the treatment, 21 patients experienced mild dizziness and nausea, but did not affect the drug use and efficacy. &lt;strong&gt;Conclusion: &lt;/strong&gt;Effects of levonorgestrel on intrauterine treatment of perimenopausal dysfunctional uterine bleeding can effectively reduce the amount of menstruation and increase hemoglobin levels. It is economic, simple, less adverse reaction, and widely entrenched in clinical practice.