Treatment Of Dysfunctional Uterine Bleeding Research Articles

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding

Objective To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. Method Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. Results At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. Conclusion Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.

An exploratory study on clinical application of radiofrequency endometrium ablation in treatment for dysfunctional uterine bleeding

目的 探讨射频子宫内膜消融术(RFEA)治疗功能失调性子宫出血的临床疗效及疗效影响因素.方法 选择自愿接受RFEA治疗的功能失调性子宫出血患者108例为研究对象,在B超监视和引导下将射频自凝刀经阴道宫颈置入子宫腔行宫内膜自凝固治疗.结果 治疗后随访6～12个月,随访104例,治疗总有效率为94.4%(102/108),治愈率即闭经率45.3%(49/108),贫血纠正率94.9%(75/79).结论 RFEA是治疗功能失调性子宫出血安全有效的微创方法;规范操作是提高疗效的关键。

Dysfunctional uterine bleeding in adolescence

This paper assesses the basic steps of management and treatment of dysfunctional uterine bleeding (DUB) – the irregular bleeding arising from anovulation. After menarche, the hypothalamic-pituitary-ovarian axis can take several years to mature resulting in anovulatory and therefore irregular cycles. During an anovulatory cycle, the corpus luteum fails to form, causing failure of normal cyclical progesterone secretion. This results in continuous unopposed production of estradiol, stimulating overgrowth of the endometrium. Without progesterone, the endometrium grows thicker and thicker eventually outgrowing its blood supply, leading to necrosis. The end result is very heavy bleeding.

Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up?

Objective The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. Study design One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. Results Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6 ± 2.2 years (range 1.5–11) after vaginal hysterectomy and 4 ± 1.8 years (range 1.5–7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. Conclusion This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.

Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception

Objective This study aims to compare the cost-effectiveness of oral contraceptives (OCs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and surgical management in treating dysfunctional uterine bleeding (DUB) in women not desiring additional children. Method A Markov model was constructed from the perspective of the health services payers for a 5-year period. Treatment costs, DUB treatment success rates and contraception success rates were obtained through a literature review. Results In women not responding to an initial trial of OCs, surgical management was more effective than the LNG-IUS (95.5% vs. 92%) but at higher cost (US$4853 vs. US$2796 per woman). Among responders to OCs, continuing treatment with the LNG-IUS instead of OCs was more effective (92% vs. 90.4%) and less expensive (US$2796 vs. US$4711). For women naïve to medical therapy, the LNG-IUS and OCs had similar effectiveness, but cost for the LNG-IUS was lower (US$2796 vs. US$4895). In all scenarios, surgery followed if medical therapy failed; rates of primary method failure were 62.5% with OCs and 34% with the LNG-IUS at 12 months. Conclusions Treatment strategies employing the LNG-IUS are the most cost-effective in managing DUB, regardless of whether a woman has previously tried OC therapy.

Pregnancy after endometrial ablation: English literature review and case report

Endometrial ablation is an effective treatment for dysfunctional uterine bleeding. The incidence of pregnancy after endometrial destruction is low and is reported to be 0.7%. We report what is to the best of our knowledge the first case of pregnancy after microwave endometrial ablation and review the outcomes of 74 pregnancies after various methods of endometrial destruction.

Successful treatment of dysfunctional uterine bleeding using laparoscopic bilateral uterine artery ligation

We present a case of dysfunctional uterine bleeding in a woman who wished to retain her fertility but found conventional treatment neither suitable nor successful. Her condition was successfully treated with laparoscopic bilateral ligation of the uterine artery.

Treatment of dysfunctional uterine bleeding in the perimenopause: The effects of adding combined estradiol/norethisterone acetate therapy to goserelin acetate treatment – a randomized, placebo-controlled, double-blind trial

Objective. To assess the effects of adding combined estradiol/norethisterone acetate therapy (CENT) to goserelin acetate treatment (GA) of dysfunctional uterine bleeding (DUB) in perimenopausal women.Methods. In a randomized, placebo-controlled, double-blind trial followed by an open follow-up study, 31 perimenopausal women with DUB were recruited from gynecological outpatient departments of two Dutch hospitals and randomized for treatment with either GA/placebo or GA/CENT for 6 months followed by 18 months of GA/CENT for all. The main outcome measures were abdominal pain, number of bleeding days, double-layer endometrial thickness (DET), Greene climacteric score (GCS), visual analog scale for well-being, bone mineral density (BMD) and mammographic density (BI-RAD score).Results. Abdominal pain, number of bleeding days and DET decreased in both groups, the between-group difference in decrease not being statistically significant. GCS initially showed significant improvement in the GA/CENT group. BMD decreased significantly in the GA/placebo group (−4.1%) compared with the GA/CENT group (−0.3%). Another 18 months of GA/CENT did not result in a lasting difference in BMD between groups. BI-RAD scores did not differ significantly between or within the two groups.Conclusions. Adding CENT to GA treatment for DUB in perimenopausal women initially prevented BMD loss and improved climacteric complaints, while having no negative impact on vaginal bleeding, abdominal pain or BI-RAD scores. However, prolonged treatment did not result in a lasting prevention of bone loss.

Developed Extrapotine Myelinolysis after Hysteroscopic Myomectomy: A case report

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.

Contraceptive information after endometrial ablation

We reviewed the records of the patients considered "fertile" in a consecutive series of 206 patients treated by intrauterine balloon ablation for dysfunctional uterine bleeding, and three pregnancies were observed among 58 patients (5.2%), with two spontaneous abortions and a placenta accreta at 26 weeks. These findings lead us to conclude that balloon ablation is not contraceptive and that use of a supplemental contraceptive method should be planned. Hysteroscopic endometrial ablation and nonhysteroscopic endometrial thermal ablation are the first-line conservative surgical treatments for dysfunctional uterine bleeding. Their use reduces the rate of hysterectomies for this common problem. Because of their effects on the endometrium and uterine cavity (synechiae), these treatments are indicated only for patients who do not wish to remain fertile.

Delayed Leiomyoma Degeneration After Microwave Endometrial Ablation

Microwave endometrial ablation is an effective treatment for dysfunctional uterine bleeding. Patients with leiomyomata, including submucosal leiomyomata up to 3 cm, may also be treated with microwave endometrial ablation. A 46-year-old woman with multiple leiomyomata and menometrorrhagia underwent microwave endometrial ablation. Two months after microwave endometrial ablation, she developed signs of peritoneal irritation. A negative laparoscopy excluded a thermal bowel injury. Imaging and clinical examination ultimately determined that her symptoms were due to leiomyoma degeneration. A 38-year-old woman with menometrorrhagia and leiomyomata underwent microwave endometrial ablation. Fifteen days after microwave endometrial ablation, she developed signs of peritoneal irritation. With a presumptive clinical diagnosis of microwave endometrial ablation degeneration, the patient was expectantly managed with pain medications and observation. Fibroid degeneration may have a delayed presentation after microwave endometrial ablation. Thermal bowel injury must be excluded in a patient presenting with signs of peritoneal irritation after microwave ablation of the endometrium before diagnosing leiomyoma degeneration, which can be managed expectantly.

Thermal endometrial ablation in dysfunctional uterine bleeding: an economic comparison of bipolar ablation and balloon ablation

Objective: A bipolar radio-frequency impedance-controlled endometrial ablation system is more effective than balloon ablation in the treatment of dysfunctional uterine bleeding. The aim of the present study was to compare the costs of both treatments, and to perform a cost-effectiveness analysis. Study design: An economic evaluation was set up alongside a randomised clinical trial comparing bipolar radio-frequency endometrial ablation and balloon ablation in 126 patients with dysfunctional uterine bleeding. Data on resources used for treatment and lost production time were prospectively collected, and costs of both treatments were calculated. Results: Mean direct medical costs per patient were €1638 for bipolar ablation and €1545 for thermal balloon ablation with a mean difference of €93 (95% CI €45–140, P-value 0.01). Mean indirect medical costs were just over €200 in each group. Incorporation of the costs of post-ablation hysterectomies resulted in mean costs of €2006 and €2053 in the balloon group (P-value 0.01). In the balloon group, the cost per satisfied patient was €2333 compared to €2112 in the bipolar group. Similarly, in the bipolar group the cost per amenorrhoeic patient was €4361 and in the balloon group €12831. Conclusions: The direct costs of bipolar ablation were higher than the costs of balloon ablation. However, after inclusion of the retreatment costs, bipolar ablation was less expensive than balloon ablation.

The treatment of dysfunctional uterine bleeding with the Mirena IUS: a survival analysis

A questionnaire was sent to 124 women with dysfunctional uterine bleeding (DUB) who had been treated with the Mirena IUS. Prior to treatment, the women had received advice about the side effects of the Mirena IUS. There was a 71% response rate of which 21% had the Mirena IUS removed prematurely. The main reasons for removal were pelvic pain and irregular vaginal bleeding. The projected Kaplan–Meier survival rate for the device over the 5-year therapeutic lifetime was 55%. The amenorrhoea rate was 38% and the oligomenorrhoea rate was 72%. The Mirena IUCD is an effective form of treatment for DUB and the majority of women are likely to continue with this treatment at 5 years.

Intrauterine instillation of trichloroacetic acid is effective for the treatment of dysfunctional uterine bleeding

To evaluate the effectiveness of trichloroacetic acid (TCA) instillation into uterine cavity for the treatment of dysfunctional uterine bleeding (DUB). Prospective clinical study. A university research hospital. Ninety women participated who had dysfunctional uterine bleeding. Ninety-five percent of TCA was instilled into uterine cavity for endometrial ablation in women with dysfunctional uterine bleeding who want conservative treatment. Participants in group 1 received only TCA; participants in group 2 received a single dose of gonadotropin-releasing hormone analogue 1 month before the procedure. All participants underwent an evaluation that included cycle history, body mass index measurement, and transvaginal ultrasonography of pelvis, diagnostic hysteroscopy and endometrial biopsy. At the end of 12 months of the treatment, amenorrhea rates in group 1 and group 2 were 26.7% vs. 31.1%, with pooled amenorrhea, hypomenorrhea, and eumenorrhea rates of 95.6% vs. 97.8%, respectively. There was no significant difference between the groups vis-a-vis postprocedure results. More than 90% of women who have this procedure are satisfied with the results. There were no observed negative effects or related complications with this treatment. An instillation of TCA into uterine cavity produces acceptable results and provides conservative management of DUB.

Long-term efficacy of transcervical endometrial resection with no preoperative hormonal preparation

Objective To assess the level of patient satisfaction after transcervical endometrial resection (TCRE) with no preoperative hormonal preparation. Study design A retrospective audit of a continuous case series was accomplished on 131 consecutive patients who underwent TCRE for dysfunctional uterine bleeding. Data of postal questionnaires were analysed and subjected to survival analysis. Results Thirty-three cases were lost to follow-up; thus, the data on 98 of the 131 (74.8%) patients were analysed. The average follow-up period was 94.8 months (60-132). Twenty (20.4%) women required D&C and 15 (15.3%) had hysterectomy. In eight of the 15 cases, the indication for hysterectomy was not related with the primary operation. The chance of avoiding hysterectomy reached a plateau after 72 months, at 78.3% (SE: 5.05%). The chance of avoiding D&C at up to 36 months was 98.6% (SE: 1.4%), and reached a plateau after 107 months at 67.11% (SE: 6.1%); 55.8% of the patients became amenorrhoeic, the remaining cases reporting good improvements in the amount and duration of bleeding, and dysmenorrhoea. Eighty-six of the 98 patients (88%) were satisfied or very satisfied with the result. Conclusions TCRE affords reasonable long-term effectiveness in the treatment of dysfunctional uterine bleeding, even without any preoperative hormonal endometrial preparation.

Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy

Objective To investigate patient preferences for endometrial ablation and a levonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectomy in the treatment of dysfunctional uterine bleeding. Design Comparative study based on structured interviews. Setting A large teaching hospital with 500 beds in the Netherlands. Patient(s) Ninety-six patients who were scheduled for endometrial ablation, 25 patients who were scheduled for hysterectomy, and 23 patients who were scheduled for a levonorgestrel-releasing IUD were interviewed. All of the women had dysfunctional uterine bleeding. Intervention(s) Patients were asked to state their most significant complaints and their reasons for choosing a particular treatment. Subsequently, the preference for endometrial ablation and a levonorgestrel-releasing IUD as alternatives to hysterectomy was assessed during a structured interview. Women were informed about the advantages and disadvantages of all three treatment options. Patients rated their preferences according to different hypothetical success rates. The success rates after endometrial ablation and levonorgestrel-releasing IUD were varied until patients found an acceptable treatment outcome. Main outcome measure(s) Patient preference of endometrial ablation and the levonorgestrel-releasing IUD over hysterectomy. Result(s) The main reason for the treatment of choice differed between the three groups. Most of the patients in the hysterectomy group wanted a definite solution to their problems, whereas patients in the levonorgestrel-releasing IUD group and in the ablation group put greater emphasis on a minimally invasive intervention with or without a short hospital stay. In women undergoing ablation, 70% of the patients preferred this treatment and the levonorgestrel-releasing IUD to hysterectomy in cases in which the success rate of noninvasive treatment was presumed to be 50%. In women having a levonorgestrel-releasing IUD inserted, 95% of the patients preferred this approach over hysterectomy in cases in which the success rate of this device was presumed to be 50%, whereas 35% of patients preferred ablation over hysterectomy in cases in which the success rate of ablation was presumed to be 50%. In women undergoing hysterectomy, 30% would have opted for ablation and 45% would have opted for a levonorgestrel-releasing IUD in cases in which success rates were 50%. Of patients who opted for hysterectomy, however, 60% stated that they would have preferred a noninvasive treatment if the success rate of this type of treatment were >80%. Conclusion(s) A majority of the patients who had dysfunctional uterine bleeding and who were scheduled for an endometrial ablation or a levonorgestrel-releasing IUD were inclined to take a risk of 50% likelihood of treatment failure to avoid a hysterectomy. As a consequence, research of treatment for dysfunctional uterine bleeding should focus on this 50% success level.

Risk of urge and stress urinary incontinence at long-term follow-up after vaginal hysterectomy

Objective The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. Study design One hundred seventeen patients who had a vaginal hysterectomy for menorrhagia from January 1991 to December 2001 answered a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. Results Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the 2 groups. Mean follow-up was 4.6±2.2 years (range, 1.5-11 years) after vaginal hysterectomy and 4±1.8 years (range, 1.5-7 years) after conservative treatment. The prevalence of urinary symptoms, which included urge and stress incontinence, was statistically similar in the 2 groups. Conclusion This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.

Levonorgestrel-releasing intrauterine system for treating menstrual disorders: a patient satisfaction questionnaire.

To establish the continuation and satisfaction rates and the reasons for removal of the levonorgestrel-releasing intrauterine system (LNG-IUS) in Palmerston North Hospital (PNH), New Zealand. All women (120) who had a LNG-IUS inserted at PNH between June 1998 and June 2002 were included in the study. A survey questionnaire regarding bleeding patterns, side-effects and satisfaction rates relating to the device as well as reasons for premature removal, current treatment for dysfunctional uterine bleeding (DUB) and contraception was sent to all 120 women. Seventy-eight of the 85 women who received the questionnaire (91%) responded to it. Thirty-five women were lost to follow-up and the overall response rate was 65%. The LNG-IUS was prematurely removed from nine women and expulsion occurred in one case. The overall continuation rate was 87%. No women had LNG-IUS removed as a result of hormonal side-effects except for bleeding abnormalities. The overall satisfaction rate was 76%. Levonorgestrel-releasing intrauterine system is a well-accepted and efficacious therapy for heavy menstrual bleeding. These satisfaction and premature removal rates compare favourably with international figures. The response rate to the questionnaire was reasonably high given the highly mobile nature of the studied population.

Diagnostics and treatment of dysfunctional uterine bleeding in the perimenopause

The reasons of dysfunctional menometrorrhagia in the perimenopause are revealed in the article , the algorithm of patient examination and necessity of differential diagnostics are given, methods of hormonal and surgical treatment of this disease are presented.

Microwave endometrial ablation for menorrhagia: outcome at 2 years--experience of a district general hospital

One hundred and twenty-three women underwent microwave endometrial ablation (MEA) for the treatment of dysfunctional uterine bleeding (DUB). The mean age at treatment was 40.2 years and the average treatment time was 2 minutes 50 seconds. All patients stayed as day cases, except for two who stayed overnight, one due to pain and the other due to urinary retention. The follow-up was carried out at 6 months, 1 and 2 years, respectively. The success rate was 80%, 76% and 70% at 6 months and 1-year and 2-year follow-up. The patient satisfaction rate was 80%, 75% and 68% at 6 months, 1 year and 2 years, respectively. However, in women 45 years old and over the success rate was more than 90%, suggesting that MEA could be a preferred procedure for treatment of DUB in this age group compared to younger women, especially in those who do not benefit from the mirena intrauterine system or decline it. Approximately 70% of patients, who underwent hysterectomy due to the failure of treatment, had uterine/pelvic pathology in the form of adenomyosis, fibroid uterus or endometriosis; therefore prior to MEA, proper patient selection is vital. There were a few minor complications but no uterine perforation or emergency hysterectomies in the group studied.