Treatment Of Abnormal Uterine Bleeding Research Articles

Tandem mass tag-based quantitative proteomic profiling of the serum of patients with abnormal uterine bleeding associated with copper intrauterine device.

To investigate changes in the level of protein in serum and uncover the underlying pathogenesis of abnormal uterine bleeding (AUB) associated with copper intrauterine devices (Cu IUD). Protein profiles were investigated via tandem mass tag (TMT)-based quantitative proteomics and bioinformatics technology. Quantification and characterization of candidate proteins were further performed in 33 controls and 45 cases by Luminex assay and enzyme-linked immunosorbent assay. In total, 842 proteins were identified via TMT coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the serum of individuals with IUDs. Among them, 25 differentially expressed proteins (p<0.05) were observed, including eight upregulated proteins and 17 downregulated proteins. Ten proteins were verified, and Alpha-1-Antitrypsin (a1AT) had a significantly elevated expression in women with AUB associated with the Cu IUD compared with healthy controls (p=0.026) and a high area under the curve value (0.656), as well as sensitivity (64.9%) and specificity (71.9%). This is the first study to explore changes in serum protein and the underlying mechanisms of AUB associated with the Cu IUD via TMT technology. a1AT with biomarker potential was validated. These findings might provide an experimental basis for the early diagnosis or treatment of AUB associated with the Cu IUD.

Patološko krvarenje iz materice kod žena u reproduktivnom periodu

Introduction: Abnormal uterine bleeding is one of the most common health disorders in women of reproductive age. In addition, it represents a significant public health problem. The aim of this paper is to present the modern classification, as well as the basis for diagnosis and treatment of abnormal uterine bleeding. Methods: This paper presents data from publications selected from the MEDLINE database using a combination of keywords: "menstrual bleeding", "abnormal uterine bleeding", "PALM-COEIN classification", "leiomyoma", "endometrial polyp", "adenomyosis", "gynecological malignancies", "coagulopathy", "diagnostics of abnormal uterine bleeding", and "treatment of abnormal uterine bleeding". The collected data from the selected studies were used and presented in this review paper. Conclusion: In order to achieve a unique classification of abnormal uterine bleeding, a classification was adopted under the name/acronym PALM-COEIN. The causes listed in the first part of the acronym (PALM) have a pathological/ anatomical cause in the reproductive organs that can be diagnosed using imaging techniques and/or histopathological examination. The causes listed in the second part of the acronym (COEIN) represent a group of dysfunctional disorders and they cannot be diagnosed using imaging techniques.

Abnormal uterine bleeding: the role of office hysteroscopy

Background. Abnormal uterine bleeding (AUB) is any menstrual cycle disorder that does not meet normal parameters of regularity, frequency, duration, and intensity. AUB are divided into acute and chronic. According to modern paradygm, when describing menstrual disorders, terms “AUB”, “heavy menstrual bleeding”, “intermenstrual bleeding”, “postmenopausal bleeding” should be used.&#x0D; Objective. To highlight the role of office hysteroscopy in the treatment of AUB.&#x0D; Materials and methods. Analysis of literature sources on this topic.&#x0D; Results and discussion. According to the etiology, AUB are classified with the help of PALM-COEIN system: P – polyp, A – adenomyosis, L – leiomyoma, M – malignancy and hyperplasia (causes of structural disorders), C – coagulopathy, O – ovulatory dysfunction, E – endometrial dysfunction, I – iatrogenic causes, N – causes not established (causes not related to structural disorders). At different ages, the main causes of AUB are different (in childhood – injuries, infections, ovarian tumors, in childbearing age – anovulation, pregnancy, endocrine disorders, in old age – endometrial cancer). When examining patients with AUB, one should carefully collect a history, carry out physical and gynecological examination, determine the condition of the thyroid gland, exclude coagulopathy and pelvic diseases. Office and even portable hysteroscopy is a modern method of visual diagnosis of AUB. Techniques for hysteroscopic removal of intrauterine pathological formations include curettage under the control of a hysteroscope, removal with forceps or laser, hysteroresectoscopy, intrauterine morcelation. Office hysteroscopy can successfully detect and treat polyps, leiomyomas, isthmocele, chronic endometritis, hyperplasia. AUB is often accompanied by iron deficiency anemia (IDA). In severe cases or in the case of planned surgical interventions, IDA require treatment with intravenous iron preparations. Clinical data show that patients with preoperative anemia treated with iron preparations before surgery do not require blood transfusions in the postoperative period. Sufer (“Yuria-Pharm”) is a trivalent iron for intravenous administration. The dose is calculated individually for each patient based on the level of hemoglobin and the severity of iron deficiency. In case of severe blood loss during the operation, it is advisable to use tranexamic acid (Sangera, “Yuria-Pharm”), which is 10 times more effective than ethamsylate and 26 times – than aminocaproic acid. In a multicenter, randomized, double-blind, placebo-controlled WOMAN study of 20,000 women with postpartum haemorrhage, tranexamic acid reduced fatalities by more than 30 % and the need for urgent surgery for hemostasis by more than 35 %.&#x0D; Conclusions. 1. AUB can have different etiology, which largely depends on the age of the patient. 2. Office hysteroscopy is a promising method of visualization diagnosis and treatment of AUB. 3. Intravenous iron preparations can be used to correct anemia after AUB, and tranexamic acid – to stop an excessive bleeding.

LNG-IUS: The best tool for non-surgical treatment of abnormal uterine bleeding and endometriosis

Introduction: The levonorgestrel- releasing intrauterine system (LNG-IUS) is the best tool for the non-surgical treatment for uterine bleeding and endometriosis. Materials and methods: Fifty-two women between the age 32 – 55 years were studied over a period of three years. Results: LNG-IUS caused 85% decrease in the amount of menstrual blood loss at 6 month and complete amenorrhea at two years. Conclusion: LNG-IUS was the best and effective to surgical management and other modes of medical treatment of abnormal uterine bleeding. The patient showed better compliance and satisfaction to the LNG-IUS. Keywords: Levonorgestrel-releasing intrauterine system (LNG-IUS), Abnormal Uterine Bleeding (AUB).

Fabrication of a Reservoir Ring for Sustained and Prolonged Release of Levonorgestrel for Vaginal Administration

Introduction: More than one-third of women experience abnormal uterine bleeding (AUB) during their lifetime. One of the treatment methods of this disease is hormone therapy. Vaginal rings (VRs) containing progesterone hormones could be a good choice for treatment. In this study, the design and construction of a reservoir ring with the ability to release levonorgestrel hormone has been investigated. Methods: In this experimental study, to make vaginal rings containing levonorgestrel, biocompatible silicone fibers were used, the two ends of which were connected with special caps. Different amounts of LNG including 0.1, 0.2 and 0.4 weight percent relative to paraffin were loaded into the fibers. These three prototypes were named RSC1, RSC2, and RSC3, respectively. The daily and cumulative release of LNG from these rings was measured by spectrophotometer and compared using SPSS software version 16 and analyzed by one-way ANOVA method. Results: On the first day, there was a burst release that was different for these three prototypes depending on the drug loading percentage. From the second until thirtieth day for RSC3 and from forth until thirtieth day for RSC1 and RSC2, prolonged release was achieved and average daily release for RSC1, RSC2, and RSC3 were 24.10 ± 8.22, 41.77 ± 9.02 and 83.29 ± 5.07µg, respectively. Conclusion: According to the findings, it is possible to design VRs capable of prolonged and sustained release of LNG for up to 30 days and control their daily release rate based on initial drug loading. This method may be a suitable alternative to oral hormonal pills in the treatment of AUB.

Effectiveness of Homeopathic Treatment for Abnormal Uterine Bleeding: A Double-Blind Randomized Clinical Trial

Background: Abnormal uterine bleeding (AUB) is a major health problem for many women. Homeopathy is one of the treatments for this disease. Objectives: This study was performed to evaluate the efficacy of homeopathic Ipecacuanha (Ipecac) in the treatment of bleeding, pain, and in the quality of life in patients with AUB compared to the control group. Methods: This double blind randomized clinical trial study was performed on women aged 35-55 years with AUB in Tehran, Iran during the years 2017-2018. In this study, patients were assigned to first group: 25 patients with routine treatment (mefenamic acid capsule) + homeopathic “Ipecac” and second group: 25 patients with mefenamic acid + placebo. Pictorial Blood Loss Assessment Chart (PBAC) score, Visual Analogue Scale (VAS) questionnaire, and General Health Questionnaire (GHQ) were utilized to assess bleeding, pain, and quality of life, respectively. Results: This study was performed on 50 women with AUB. In this study, the two groups were similar in demographic characteristics. The results showed that despite the relative improvement in PBAC score, duration of bleeding, and depression score in the homeopathic treatment group, this decrease was not statistically significant. The homeopathic treatment group compared to the control group showed more improvement in pain score, physical symptoms, anxiety and insomnia, social dysfunction, and mental health. Conclusion: Considering the efficacy of homeopathic “Ipecac” in reducing pain and increasing the quality of life of women with AUB in this study, it can be suggested in AUB without the complication of this treatment.

Combined transcervical endometrial resection and levonorgestrel device treatment compared to transcervical endometrial resection for abnormal uterine bleed.

Transcervical resection of the endometrium (TCRE) is a first-line surgical treatment of abnormal uterine bleeding. However, many women experience unsuccessful results, causing hysterectomy in up 17% of cases. The aim of this study was to describe the odds of hysterectomy in women with abnormal uterine bleeding, treated with TCRE and levonorgestrel intrauterine contraceptive device (TCRE+LNG-IUCD) or TCRE alone. The secondary aim was to analyze the rate of amenorrhea. Designed as a retrospective cohort study, and conducted at Odense University Hospital, Denmark, the study included women with abnormal uterine bleeding, who underwent TCRE from January 2013 to December 2015. The decision of treatment with respect to LNG-IUCD was at the woman's discretion. Data were collected from medical records and a self-reported retrospective bleeding-pattern questionnaire. A multivariate regression model was used, enabling adjustment for potential and identified confounders. Out of 432 women, 276 (62%) consented to inclusion and of these, 16 (4%) were excluded. In total 88 (34%) received combined treatment and 172 (66%) received TCRE alone. Ten women (11%) treated with TCRE+LNG-IUCD underwent hysterectomy, compared with 27 (16%) treated with TCRE alone (OR=0.69, 95% CI 0.28-1.56; P=.34). Multivariate analysis disclosed a significant effect of TCRE+LNG-IUCD (OR=0.35, 95% CI 0.13-0.97; P=.04) on hysterectomy. The presence of fibromas was shown to increase the odds of treatment failure, resulting in hysterectomy (OR 2.69, 95% CI 1.15-6.31; P=.02). Furthermore, the incidence of amenorrhea was 59% in the TCRE+LNG-IUCD group and 36% in the TCRE alone group (OR=2.56, 95% CI 1.46-4.49; P<.01). The study showed significantly lower odds of hysterectomy in the TCRE+LNG-IUCD group when adjusted for confounders. Combination treatment improves the bleeding patterns significantly compared with monotherapy with TCRE.

Long-term outcome of endometrial ablation therapy with Cavaterm Thermal Balloon in patients with abnormal uterine bleeding

Objective:The purpose of this study was to evaluate the long-term outcome of endometrial ablation (EA) therapy with Cavaterm Thermal Balloon in patients with abnormal uterine bleeding (AUB).Material and MethodsThe retrospective cross-sectional study was performed on 209 patients who referred to Shahid Sadoughi Hospital in Yazd, Iran between March 2010 and September 2017 with AUB undergoing EA therapy. The data was collected by a questionnaire from the medical records of patients and phone call. The primary and secondary outcomes post EA therapy (from six months to seven years post-operatively) were assessed in patients.Results:The mean age of participants was 45.9±5.9 years and the mean follow-up duration was 21.2±13.2 months. The rate of treatment response was 95% in the first six months and 92.1% thereafter. The prevalence of amenorrhea was 41.2%. The patient satisfaction rate at the end of follow-up duration was 81.3%. Dysmenorrhea completely resolved in 32.6%. Moreover, 1.4% of patients became pregnant during follow-up. By the end of follow-up, four (1.9%) patients had a hysterectomy due directly to treatment failure.Conclusion:This study showed that EA surgery with Cavaterm Thermal Balloon was an effective treatment for AUB. The procedure was safe and was associated with a very low rate of postoperative adverse events. The patient satisfaction rate was favorable.

Efficacy and Safety of Ormeloxifene versus low dose OCP in the treatment of Abnormal Uterine Bleeding (AUB)

Efficacy and Safety of Ormeloxifene versus low dose OCP in the treatment of Abnormal Uterine Bleeding (AUB)

Employer-perspective cost comparison of surgical treatments for abnormal uterine bleeding.

Aim: To estimate direct and indirect costs of surgical treatment of abnormal uterine bleeding (AUB) from a self-insured employer's perspective. Methods: Employer-sponsored insurance claims data were analyzed to estimate costs owing to absence and short-term disability 1 year following global endometrial ablation (GEA), outpatient hysterectomy (OPH) and inpatient hysterectomy (IPH). Results: Costs for women who had GEA are substantially less than costs for women who had either OPH or IPH, with the difference ranging from approximately $7700 to approximately$10,000 for direct costs and approximately $4200 to approximately $4600 for indirect costs. Women who had GEA missed 21.8-24.0 fewer works days. Conclusion: Study results suggest lower healthcare costs associated with GEA versus OPH or IPH from a self-insured employer perspective.

Recurrence and prediction of abnormal uterine bleeding and re-intervention after initial hysteroscopic treatment: a retrospective cohort study.

To estimate the incidence of recurrence of complaints and repeated interventions after hysteroscopic treatment for abnormal uterine bleeding in premenopausal women and to determine potential predictors for re-intervention. This is a retrospective cohort study in two secondary care centers in the Netherlands. We included 313 premenopausal women who underwent hysteroscopy for complaints of abnormal uterine bleeding and who had intrauterine pathology visualized at ultrasound. The intrauterine structure was hysteroscopically removed. These women were compared with women who had a hysteroscopy for abnormal uterine bleeding, but in whom hysteroscopy showed no abnormalities. We used Chi-squared test for categorical variables and independent-samples T test for continuous variables. p Values less than 0.05 were considered to indicate statistical significance. In total, 262 women had intrauterine pathology removed at hysteroscopy; 136 (52%) women had recurrence of complaints, while 101 women (39%) underwent re-intervention. Heavy menstrual bleeding at baseline and multiparity were predictive factors for recurrence of abnormal uterine bleeding and re-intervention. In the 51 women with abnormal uterine bleeding in whom hysteroscopy showed no intrauterine abnormality, 29 women (60%) had recurrence of complaints and 12 (24%) a re-intervention. In premenopausal women with abnormal uterine bleeding, treatment of intrauterine pathology often does not reduce the complaints, thus questioning the effectiveness of hysteroscopic removal of these structures.

“Everything Was Blood When It Comes to Me”: Understanding the Lived Experiences of Women with Inherited Bleeding Disorders

Introduction: Despite the manifold symptoms that women with inherited bleeding disorders may experience, no study has specifically sought to understand the lived experiences of these women, nor the barriers to care that they may face. Indeed, the literature on this topic remains sparse. A MEDLINE search assessing literature on access to care for women with inherited bleeding disorders yielded 526 abstracts; of these, only a small subset (N=12) focused on women's health, and less (N=2) made any note of potential barriers to care. Given the lack of data on this subject to date, the objective of this qualitative descriptive study was to understand women's lived experiences with inherited bleeding disorders, and their perceptions around access to care. Methods: A semi-structured qualitative interview guide was developed in conjunction with experienced hematologists (MS and RW), patient advocates from the Canadian Hemophilia Society (CHS; PW and DP), and a qualitative research expert (KD). Inclusion criteria for study enrollment included age ≥ 18 years old, English-speaking, and confirmed diagnosis of an inherited bleeding disorder. Women were recruited across Canada through identification by treating healthcare providers and study members of the CHS. They were then consented for telephone interview by SA. Interviews were transcribed verbatim, and analyzed using descriptive thematic analysis on NVIVO software. A random selection of interviews was coded by 2 team members (SA, KD) to ensure similar data interpretation. Results: Ten interviews with women with bleeding disorders were completed. Ages ranged from 24-70, and diagnoses included hemophilia B carriership (N=2), hemophilia A carriership (N=2), von Willebrand disease (N=2), disorders of platelet function (N=3) and dysfibrinogenemia (N=1). Common themes in the data included diagnostic uncertainty, affected family members, bleeding disorders' effect on life, the importance of treatment plans, experienced barriers, and access to care factors (Table 1). The most common barriers to care noted were healthcare provider dismissal of bleeding symptoms, lack of healthcare provider awareness, geographical barriers, and perceived barriers specific to women. Patients noted the importance of as-needed treatment, treatment for abnormal uterine bleeding, iron supplementation, and the need for family planning. They also highlighted the importance of access to clinic and treatment, and the need for self-advocacy. Discussion: To our knowledge, this is the first study to assess lived experiences and barriers to care for women with inherited bleeding disorders. Our data indicates that women often feel dismissed by healthcare providers, and feel disempowered by not feeling understood or heard. These results may have implications for the ways in which healthcare providers communicate with their patients, particularly in the face of diagnostic uncertainty or predominantly gynecologic-related bleeding symptoms. By better understanding patients' lived experiences, providers may be able to provide more comprehensive, person-centered care. Disclosures Teitel: Novo Nordisk: Consultancy; Octapharma: Consultancy; CSL Behring: Consultancy; Pfizer: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; Shire: Consultancy; BioMarin: Consultancy. Sholzberg:Novartis: Honoraria; Amgen: Honoraria, Research Funding.

1736 Novel Approach to Repair of Laparoscopic Cystotomy

Video Objective This video aims to demonstrate an interesting incidental cystotomy created laparoscopically during a total hysterectomy, demonstrate best practices for repair techniques, and review relevant anatomy. Setting Our patient is a 47 year old G7P3223 with a prior surgical history of 4 cesarean sections, who presents for total laparoscopic hysterectomy and bilateral salpingectomy as definitive treatment for abnormal uterine bleeding (AUB) due to leiomyomas. The surgery takes place at a large tertiary medical center. During creation of the colpotomy, a through and through anterior cystotomy and a partial thickness posterior cystotomy is incidentally created. Illustrations of relevant anatomy demonstrate how the colpotomy is created and which areas of the bladder need to be repaired. Interventions The extent of the cystotomy is assessed by guiding the laparoscope into the bladder via the cystotomy. The ureteric orifices are found to be intact bilaterally. The repair is then performed laparoscopically. First, the partial thickness posterior cystotomy is repaired in two layers. The first layer is a running non-locking stitch that is started in an inside-to-out followed by an outside-to-in fashion, allowing the knot to be buried below the mucosa. The second layer is an imbricating baseball stitch burying the mucosal layers. Next, the anterior full thickness cystotomy is repaired in two running non-locking layers burying all knots outside the bladder to prevent a nidus for stone formation and other complications. The bladder is backfilled to assure a water tight seal and the hysterectomy is continued. Conclusion Our video demonstrates an interesting cystotomy that involves both the anterior and posterior walls of the bladder and evaluation of the trigone from the abdominal side. It summarizes and illustrates best practices for bladder injury repair laparoscopically and relevant anatomy. Finally, it reviews necessary intraoperative care after repair, including retrograde filling of the bladder and cystoscopy, and postoperative care.

2484 Clinical Outcomes Among Women with Abnormal Uterine Bleeding Treated with Inpatient or Outpatient Hysterectomy Versus Endometrial Ablation

Study Objective To describe clinical and economic outcomes among women with abnormal uterine bleeding (AUB) treated with global endometrial ablation (GEA) versus inpatient and outpatient hysterectomy. Design US retrospective claims analysis. Setting N/A. Patients or Participants Women undergoing GEA or hysterectomy (index event) between 1/1/2012 and 4/30/2017 with ≥2 non-diagnostic claims indicating AUB before or on the index date in the IBM MarketScan Commercial Database. Women were required to have 12 months pre- and post-index continuous enrollment. Women with evidence of pregnancy, delivery, menopause, non-skin cancer or receiving total abdominal hysterectomy were excluded. Follow-up healthcare costs and the incidence of complications (such as cervical occlusion, cervical/uterine/bowel perforation, fluid overload, pyometra, cervicitis, device complications and cervical trauma) were reported. Re-intervention, defined as hysterectomy or repeat GEA, was reported during the five-year post-index among GEA patients. Interventions GEA or hysterectomy. Measurements and Main Results 117,801 women met the study criteria (56.6% GEA, 43.4% hysterectomy). 84.0% of hysterectomy cases occurred in an outpatient setting. Mean age was lower for GEA patients (42.7 vs. 43.2). Total healthcare costs in the first month post-index among GEA patients were less than one-half of hysterectomy ($7,018 vs. $15,402), a similar finding when limited to inpatient ($17,672) or outpatient hysterectomy ($14,971) (all p Conclusion This analysis of a large, national claims database found that GEA was approximately one-half the cost of hysterectomy (inpatient or outpatient) for the treatment of AUB with fewer complications and declining rates of re-intervention.

Dramatic response of Mirena (levonorgestrel intrauterine system) in treatment of menorrhagia

Background: Menorrhagia is a type of menstrual disorder that is characterized by the presence of red vaginal discharge from the uterine cavity on a regular basis, but excessive in quantity (greater than 80 ml) and / or duration (greater than 7 days). Objective: To study the dramatic response of levonorgestrel intrauterine system (LNG-IUS) Mirena for treatment of menorrhagia during its use as contraceptive. Matera and methods: 30 women between 30 and 50 year with menorrhagia were included in a study over two year. Response was assessed monthly for first 4 month and then yearly for maximum 2 year. Result; Mirena caused decrease in blood loss (MBL) in 16.7% of the patients at 4 month, 73.3% decrease in(MBL) by one year and 100% decrease by 2 years, and improved the mean Hb level in 100% of the patients after 2 years. Mirena has an effective in treatment of abnormal uterine bleeding and this made surgical intervention (Hysterectomy) is last choice. Conclusion: LNG locally released on endometrium cavity is both a safe and reliable method of abnormal uterine bleeding treatment.

Endometrial ablation; less is more? Historical cohort study comparing long-term outcomes from two time periods and two treatment modalities for 854 women.

BackgroundAbnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only.Materials and methodsHistorical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006–2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992–1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method.ResultsDuring 2006–2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation.Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12–14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23–26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001.ConclusionsEndometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.

The surgical treatment of idiopathic abnormal uterine bleeding: An analysis of 88 000 patients from the French exhaustive national hospital discharge database from 2009 to 2015

ObjectiveThe objective of the study was to compare success rates, complications and management costs of different surgical techniques for abnormal uterine bleeding (AUB).MethodsThis was a retrospective analysis of the French national hospital discharge database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure code between 2009 and 2015 inclusive were identified, concerning 109,884 women overall. Outcomes were compared between second generation procedures (2G surgery), first-generation procedures (1G surgery), curettage and hysterectomy. Clinical outcomes were treatment failure and complications during the follow-up period. Costs were attributed using standard French hospital tariffs.Results7,863 women underwent a 2G procedure (7.2%), 39,935 a 1G procedure, (36.3%), 38,923 curettage (35.4%) and 23,163 hysterectomy (21.1%). Failure rates at 18 months were 9.9% for 2G surgery, 12.7% for 1G surgery, 20.6% for curettage and 2.8% for hysterectomy. Complication rates at 18 months were 1.9% for 2G surgery, 1.5% for 1G surgery, 1.4% for curettage and 5.3% for hysterectomy. Median 18-month costs were € 1 173 for 2G surgery, € 1 059 for 1G surgery, € 782 for curettage and € 3 090 for hysterectomy.ConclusionCurettage has the highest failure rate. Hysterectomy has the lowest failure rate but the highest complication rate and is also the most expensive. Despite good clinical outcomes and relatively low cost, 1G and 2G procedures are not widely used. Current guidelines for treatment of AUB are not respected, the recommended 2G procedures being only used in <10% of cases.

Impact of luteinizing hormone suppression on hematopoietic recovery after intensive chemotherapy in patients with leukemia.

7039 Background: Treatment of acute leukemia with intensive chemotherapy (IC) leads to increased risk of infection and bleeding because of myelosuppression. Luteinizing hormone (LH) blockade was found to improve hematopoietic recovery in mice after radiation or chemotherapy through protection of the hematopoietic stem cells (HSCs) which express the LH receptor (Velardi et al, Nat Med 2018). We hypothesized that LH blockade improves hematopoietic recovery following IC in patients (pts) with leukemia. Methods: We assessed gene expression of the LH receptor (LHR) in lineage-specific normal and AML hematopoietic cells from a reference dataset (Corces et al, Nat Gen 2016). We conducted a retrospective analysis on pre-menopausal women with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) who received IC and Lupron, given for prevention or treatment of abnormal uterine bleeding. Results: LHR was greatest in HSCs, with little or no expression in mature subtypes within the hematopoietic hierarchy. Surprisingly, LHR was expressed on blasts. Since Lupron was more commonly given in younger pts, we performed propensity matching between the Lupron groups (AML N = 64; ALL N = 49) and control (Ctrl) groups (AML N = 128; ALL N = 98 pts). Baseline characteristics including blood counts were well balanced. Pts with AML who had received Lupron had a significantly higher increase in their platelet count following IC (13.8x109/L/year vs Ctrl; p = 0.02). Pts with ALL who had received Lupron had significantly higher increase in their absolute neutrophil count (0.37x109/L/year vs Ctrl; p = 0.02). AML pts in the Lupron group received significantly less blood transfusions vs Ctrl (mean: 23.9 vs 34.7 units; P = 0.002) and less platelet transfusions (mean: 24.4 vs 32.8 units; P = 0.06). There was no difference in event-free and overall survival between the groups in each leukemia cohort. Conclusions: Lupron use in leukemia pts receiving IC was associated with improved long-term blood count recovery. It was also associated with decreased transfusion requirements in AML. Despite expression of the LHR in blasts in addition to normal HSCs, there was no effect of LH blockade on rates of leukemia relapse or death.

Prediction of unsuccessful endometrial ablation: a retrospective study

BackgroundEndometrial ablation (EA) is a frequently used treatment for abnormal uterine bleeding, mainly due to the low risks, low costs and short recovery time associated with the procedure. On the short term, it seems successful, long-term follow-up however, shows decreasing patient satisfaction as well as treament efficacy. There even is a post-ablation hysterectomy rate up to 21%. Multiple factors seem to` influence the outcome of EA. Due to dissimilarities in and variety of these factors, it has not been possible so far to predict the success rate of EA based on pre-operative factors.Therefore, the aim of this study is to develop two prediction models to help counsel patients for failure of EA or necessity of surgical re-intervention within 2 years after EA.MethodsWe designed a retrospective two-centred cohort study in Catharina Hospital, Eindhoven and Elkerliek Hospital, Helmond, both non-university teaching hospitals in the Netherlands. The study population consisted of 446 pre-menopausal women who underwent EA for abnormal uterine bleeding, with a minimum follow-up time of 2 years. Multivariate logistic regression analysis was used to create the prediction models.ResultsThe mean age of the patients was 43.8 years (range 20–55), 97.3% had complaints of menorrhagia, 57.4% of dysmenorrhoea and 61.0% had complaints of intermittent or irregular bleeding. 18.8% of patients still needed a hysterectomy after EA. The risk of re-intervention was significantly greater in women with menstrual duration > 7 days or a previous caesarean section, while pre-operative menorrhagia was significantly associated with success of EA. Younger age, parity ≥ 5 and dysmenorrhea were significant multivariate predictors in both models. These predictors were used to develop prediction models, which had a C-index of 0.71 and 0.68 respectively.ConclusionWe propose two multivariate models to predict the chance of failure and surgical re-intervention within 2 years after EA. Due to the permanent character of EA, the increasing number of post-operative failure and re-interventions, these prediction models could be useful for both the doctor and patient and may contribute to the shared decision-making.

PIH16 ECONOMIC AND CLINICAL OUTCOMES AMONG WOMEN WITH ABNORMAL UTERINE BLEEDING TREATED WITH INPATIENT OR OUTPATIENT HYSTERECTOMY VERSUS ENDOMETRIAL ABLATION

To describe economic and clinical outcomes among women with abnormal uterine bleeding (AUB) treated with global endometrial ablation (GEA) versus hysterectomy. Women undergoing GEA or hysterectomy (index event) between 1/1/2012 and 4/30/2017 with ≥2 non-diagnostic claims indicating AUB before or on the index date in the IBM MarketScan® Commercial Database. Women were required to have 12 months pre- and post-index continuous enrollment. Outcomes included initial procedure and follow-up total healthcare costs and the incidence of complications. Re-intervention, defined as second GEA or hysterectomy, was reported up to five years post-index among GEA patients. 117,801 women met the inclusion criteria (56.6% GEA, 43.4% hysterectomy). The majority of hysterectomy cases (84.0%) occurred in an outpatient setting. Mean age was slightly lower for GEA patients (42.7 vs. 43.2, p<0.001). Total healthcare costs during the 12-month pre-index were lower for GEA than hysterectomy ($7,291 vs. $8,847, p<0.001). Total healthcare costs in the first month post-index among GEA patients were less than one-half of hysterectomy ($7,018 vs. $15,402, p<0.001), a similar finding when limited to inpatient ($17,672) or outpatient hysterectomy ($14,971) (both p<0.001). Total costs over the entire first year of follow-up were likewise lower for GEA than hysterectomy ($13,719 vs. $6,282) for both inpatient ($24,497) and outpatient ($21,149) hysterectomy (all p<0.001). Complications were more common among inpatient and outpatient hysterectomy than GEA patients (22.2% and 16.8% vs. 5.0%, both p<0.001). Among GEA patents, the rates of re-intervention declined from 5.5% to 2.2% from 1st to 5th year post-index; the cumulative re-intervention rate was 16.8% over 5 years. This analysis of a large, national administrative claims database found that GEA was approximately one-half the cost of hysterectomy for the treatment of AUB with fewer complications and low re-intervention rates over a 12-month follow-up period.