Treatment Of Abnormal Uterine Bleeding Research Articles

Late complications of operative hysteroscopy

The late complications of operative hysteroscopy result from either persistent endometrium after ablation or myometrial damage during surgery. Residual endometrium can become neoplastic, cause pain, or support a pregnancy. Myometrial damage can produce catastrophic consequences during a later pregnancy. These long-term problems place the impetus on the operating physician to select patients carefully, prepare the endometrium, and operate in such a way as to minimize the likelihood of residual endometrium and unnecessary myometrial damage. The value of operative hysteroscopy for infertility secondary to adhesions and uterine septa is unequivocal. Hysteroscopic surgery offers increased fertility rates while avoiding the risks of open surgery. For the treatment of abnormal uterine bleeding, endometrial ablation can be performed safely, and the long-term benefits are durable. As more operative hysteroscopy is performed, more delayed complications will arise. Easy-to-perform global ablation techniques and multifunctional operative hysteroscopes have enticed more gynecologists to test the waters of endometrial ablation and operative hysteroscopy. Although they empower the hysteroscopist to offer more advanced and more valuable minimally invasive options to patients, these tools simultaneously can tempt the surgeon to forego meticulous preoperative evaluation. Evidence exists that too often women undergo surgery without complete diagnostic assessment. In one study, 50% of women underwent hysterectomy without any diagnostic evaluation of the endometrium. Hysterectomy possesses a saving grace in that it provides cover for many missed diagnoses. Conservative, nonextirpative procedures offer no such life raft. Meticulous diagnostic assessment and preoperative consideration of risk factors for residual endometrium and future pregnancy remain the keys to minimizing late complications.

ALTERNATIVES TO HYSTERECTOMY FOR THE TREATMENT OF EXCESSIVE UTERINE BLEEDING

SUMMARYAbnormal uterine bleeding is a common gynaecological problem that traditionally has been treated with hysterectomy. However, there are many other conservative treatment modalities that should be considered before hysterectomy. Medical therapies are effective in most cases. Endometrial ablation may be an effective surgical alternative to hysterectomy. This article reviews and updates the diagnostic concepts and management options for the treatment of abnormal uterine bleeding. The authors present a review of the pertinent literature and describe their experience with the latest balloon device for endometrial ablation therapy. (Int J Clin Pract 2000; 54(4): 233‐237)

Elevated level of basic fibroblast growth factor in leiomyoma-related abnormal uterine bleeding and its reversal by interferon-α

Objectives: To test for the first time the role of basic fibroblast growth factor (b-FGF) in abnormal uterine bleeding from myoma; to test for the first time in the literature the role of interferon-α as a new modality in the treatment of abnormal uterine bleeding by myoma; to test for the first time the role of interferon-α in the treatment (nonsurgical) of the myoma.Methods: Twenty patients with multiple myoma, with abnormal uterine bleeding, and 20 control patients with no abnormal uterine bleeding as a control group were enrolled in the study. Serum levels of EGF were measured in the three groups. Interferon-α treatment was started for 1 week in both groups with abnormal bleeding. Measurement of uterine volume in the myomatous groups before and after treatment was performed.Results: A statistically significant increase in b-FGF is seen in the myomatous bleeding group; P <0.05 in the nonmyomatous bleeding group and the control group. Also, there was a statistically significant decrease in the amount of myomatous blood loss in the nonmyomatous group after 1 week of treatment with interferon-α; (P <0.05). There was also a statistically significant decrease in the uterine volume of the myomatous group after treatment with interferon-α (P <0.001).Conclusions: Patients with Leiomyoma related bleeding had elevated levels of b-FGF in the endometrium. They also had abnormal patterns of b-FGF. Interferon-α can effectively stop the bleeding from a myomatous uterus. A new mechanism of bleeding with myoma and a new line of treatment have been born. Basic fibroblast growth factor is an important in the regulation of human uterine cells, and a new line of treatment for myoma has been born (ie, interferon).

Preliminary data from multi-center study using cryogen first option uterine cryoblation therapy in women with abnormal uterine bleeding

Objective: To evaluate the safety and effectiveness of the First Option Uterine Cryoblation Therapy in women with abnormal uterine bleeding (AUB).Methods: A multicenter study is underway to evaluate uterine cryoblation under ultrasound guidance for women with AUB, compared with electrosurgical ablation. All patients are pre-menopausal, are menorrhagic with a diary score greater than 150, have failed medical therapy, have a uterine volume of 300 or less with a uterine sound of 10 or less, and are free of endometrial pathology on ultrasonography, biopsy, and hysteroscopy. Intramural fibroids did not exclude patients from participation unless they were greater than 2 cm in diameter.Results: Data on 87 patients at 6 months shows an amenorrhea/staining outcome of 54%. Overall success as measured by diary score of 75 or less is 90%. Sixty-three percent of the electrosurgery patients were given general anesthesia, compared with 29% of the cryoblation patients. Thirty-five percent of the cryoblation patients received as paracervical block and conscious sedation, compared with only 1% of the electrosurgery group. The procedure has been done successfully in the operating room, procedure room, or office with no major complications to date.Conclusions: Preliminary data indicates that uterine cryoblation is a safe and effective treatment for AUB.

Retrospective analysis of 195 cases for treatment of abnormal uterine bleeding to compare clinical and economic outcomes

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C50-C51 Free communication Current topics in gynecology Retrospective analysis of 195 cases for treatment of abnormal uterine bleeding to compare clinical and economic outcomes Jay Berman, Jay BermanSearch for more papers by this author Jay Berman, Jay BermanSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)81594-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C50-C51 RelatedInformation

Totale hysteroskopische Endometriumresektion: Eine kritische Analyse der Indikationen, Technik und Ergebnisse

An der Geburtshilflich-gynäkologischen Abteilung des Landeskrankenhauses Deutschlandsberg wurden vom 1. August 1992 bis einschliesslich 31. Mai 1997 insgesamt 130 totale hysteroskopische Endometriumresektionen (ER) durchgeführt. Bei 115 Patientinnen (88,5%) bestanden ausgeprägte therapieresistente Blutungsstörungen in Form von Hypermenorrhöen und Menorrhagien, oft kombiniert mit Poly- und Dysmenorrhöen. 15 Frauen (11,5%) entwickelten nach einem operierten Mammakarzinom unter einer Dauertherapie mit Tamoxifen Endometriumhyperplasien bzw. Korpuspolypen, welche nach hysteroskopisch-bioptischer Abklärung bzw. Resektion in einer zweiten Sitzung reseziert wurden. Als Ursache der abnormen Blutungen fand sich bei 98 von 115 Patientinnen (85,2%) eine pathologische Veränderung im Bereich der Gebärmutter and somit eine organische Ursache der Blutungsstörung. Lediglich bei insgesamt 17 Frauen (14,8%) war eine dysfunktionelle uterine Blutung (12 Fälle) oder eine iatrogen herabgesetzte Gerinnungsfähigkeit des Blutes (5 Fälle) zu beobachten. Die überwiegende Mehrzahl der Frauen (106 Fälle = 81,5%) war älter als 40 Jahre. Das durchschnittliche Alter betrug 46,9 ± 6,21 Jahre. Alle ER wurden unter Intubationsnarkose vorgenommen, wobei die gesamte Gebärmutterhöhle mit der Resektoskopschlinge bis zum inneren Muttermund reseziert wurde. Von insgesamt 130 Patientinnen wurde bei 92 (70,8%) vor der ER eine Hysteroskopie bzw. eine getrennte Kürettage durchgeführt. Eine medikamentöse Vorbehandlung zur Atrophisierung des Endometriums erfolgte bei 77 Patientinnen (66,9%). Bei 15 Frauen (13,0%) wurde in der gleichen Sitzung eine laparoskopische Tubensterilisation vorgenommen. Nach Abzug der Patientinnen unter Dauerbehandlung mit Tamoxifen und einer zu kurzen Nachbeobachtungszeit von weniger als 6 Monaten sowie der Drop-outs repräsentieren schliesslich 107 Patientinnen, alle mit Blutungsstörungen, unsere derzeitigen Ergebnisse. Bei einer Nachbeobachtungszeit von mindestens 6 bis 58 Monaten lag die Erfolgsrate bei 84.1%. Davon blieben 45,6% der Frauen amenorrhoisch, 41,1% hypomenorrhoisch und 13,3% der Patientinnen eumenorrhoisch. Demgegenüber stehen 17 Frauen (15,9% mit Rezidiven. 11 Patientinnen bekamen ein Blutungsrezidiv, bei 3 Patientinnen war das Blutungsrezidiv mit einer neu aufgetretenen Dysmenorrhö kombiniert, und 3 amenorrhoische Frauen klagten über therapieresistente zyklische Schmerzen. Als Rezidivbehandlung wurden 7 Zweitresektionen durchgeführt, wobei bei 1 Patientin nach einem neuerlichen Blutungsrezidiv der Uterus exstirpiert werden musste. Von den restlichen 10 Patientinnen wurden 9 hysterektomiert, 1 Patientin lehnte jede weitere Therapie ab. Die gesamte Hysterektomierate betrug 12,2 %. Von der Grundidee her hat die ER einen durchaus reellen Stellenwert bei der Behandlung abnormer uteriner Blutungen, zumal dadurch in vielen Fällen eine Hysterektomie vermieden werden kann. Zufriedenstellende Langzeitergebnisse können jedoch nur erzielt werden, wenn an die Indikationsstellung und Operationstechnik hohe qualitative Ansprüche gestellt werden. Ein nach wie vor ungelöstes Problem betrifft die Indikationsstellung und die Behandlung der proliferierenden Adenomyosis uteri interna.

Diagnosis and treatment of abnormal uterine bleeding in postmenopausal patients using hormone replacement therapy

ObjectiveTo investigate the cause of uterine bleeding in menopausal patients using hormone replacement therapy (HRT), and the efficacy of resectoscopic surgery for treatment of irregular vaginal bleeding caused by benign uterine pathology in such patients.DesignRetrospective case series.SettingEndoscopy unit of a private urban hospital.Subjects143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997.InterventionsAll the patients were evaluated using transvaginal sonography, hysteroscopy and endometrial biopsies. A total of 87 patients with polyps, myomas or an atrophic uterine cavity underwent polypectomy (n = 64) and myomectomy (n = 19) in association with endometrial resection (n = 87).ResultsEndometrial polyps and submucous myomas were the most frequent cause of uterine bleeding in postmenopausal women using HRT. These conditions could be treated effectively using the resectoscope. The failure rate of resectoscopic surgery for focal lesions in patients receiving HRT was 6%. Adenomyosis and recurrence of endometrial polyps were the most frequent reasons for treatment failure and resumption of vaginal bleeding.ConclusionUterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.

Redução Endometrial por Vídeo-Histeroscopia: experiência em um Hospital de Ensino

Objetivo: demonstrar a efetividade da redução endometrial vídeo-histeroscópica no tratamento do sangramento uterino anormal. Métodos: foram analisados os prontuários de 60 pacientes com sangramento uterino anormal não-controlado clinicamente. Resultados: oitenta e oito por cento das pacientes tiveram resposta adequada ao tratamento (53,3% oligomenorréia e 35% amenorréia). Foi encontrado um índice de 8,3% de complicações (5 perfurações uterinas). Conclusão: a redução endometrial vídeo-histeroscópica é uma técnica eficaz no tratamento do sangramento uterino anormal não-controlado clinicamente, com baixos índices de complicações intra e pós-operatórias.

The decision-making process for the treatment of abnormal uterine bleeding.

This pilot study was conducted to investigate the treatment decision-making process of patients and physicians for abnormal uterine bleeding (AUB). Frequently, women with AUB are referred for hysterectomy without diagnostic workup, alternative therapeutic management, or patient input (i.e., patient treatment preferences). Variations in treatment strategies used for patients may be related to a number of factors external to the patient's underlying disease. However, little is known about which factors are most influential or about the extent to which they influence physicians' and patients' decisions. We prospectively followed the management and treatment of 52 women with complaints of AUB and examined differences in treatment among these patients. Extensive previsit interviews were conducted with these women to identify each patient's symptoms, health status, functional status, and preferences for and expectations of treatment. We then conducted telephone interviews within a week of the visit and again 9-12 months later to determine the treatment plan, patient level of participation in and satisfaction with the treatment, symptoms, and functional status. Overall, our findings suggest that patients want to be involved in making treatment decisions and that when women were presented with alternatives to hysterectomy, many chose alternative medical therapy or other surgical procedures. In addition, women reported that these alternative treatments produced significant improvement in symptom intensity and functioning. Increased patient participation in decision making enhanced patient satisfaction. These findings suggest that hysterectomy rates may be decreased by offering women alternative treatments and by finding ways to increase women's participation in their treatment decisions.

Retrospective analysis of 305 consecutive cases of endometrial ablation and partial endomyometrial resection

To assess the efficacy and safety of operative resectoscopy, partial endomyometrial resection, and endometrial ablation in the evaluation and treatment of abnormal uterine bleeding. Retrospective analysis of 305 consecutive cases of endometrial ablation and partial endomyometrial resection. Midwestern urban obstetric and gynecology group practice and teaching hospitals. Three hundred five women (age 30-72 yrs) with abnormal uterine bleeding. Interventions. Partial endomyometrial resection and endometrial ablation. Of the 301 patients who completed surgery and follow-up, 283 (97%) reported improvements in amenorrhea (55%), hypomenorrhea (41%), and eumenorrhea (1%). Ten (3%) failed to report improvement. In 24 (7.9%) women, hysterectomy was performed for various reasons after endometrial ablation, including recurrent bleeding in 4. Four uterine perforations occurred, infection was suspected in one patient, and loss of Laminaria occurred in another; all patients, however, were observed appropriately and discharged the same day of surgery. Partial endomyometrial resection and endometrial ablation is a safe and effective treatment of abnormal uterine bleeding, and may be an alternative to hysterectomy in selected patients.

Hysteroscopy versus hysterectomy for the treatment of abnormal uterine bleeding: A comparison of cost: Brumsted J.R.; Blackman J.A.; Badger G.J.; Riddick D.H. USA Fertil Steril 1996 65/2 (310–316)

International Journal of Gynecology & ObstetricsVolume 54, Issue 2 p. 209-209 Citations from the literature general problems in gynecology Hysteroscopy versus hysterectomy for the treatment of abnormal uterine bleeding: A comparison of cost Brumsted J.R.; Blackman J.A.; Badger G.J.; Riddick D.H. USA Fertil Steril 1996 65/2 (310–316) First published: August 1996 https://doi.org/10.1016/0020-7292(96)83031-1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume54, Issue2August 1996Pages 209-209 RelatedInformation

Hysteroscopy versus hysterectomy for the treatment of abnormal uterine bleeding: a comparison of cost

To compare the costs of hysteroscopic treatment of abnormal uterine bleeding with the costs associated with abdominal and vaginal hysterectomy. Retrospective review. Academic medical center and outpatient gynecology practice. A list of all women undergoing an endometrial ablation (n = 60), hysteroscopic myomectomy (n = 14), abdominal (n = 192), or vaginal (n = 37) hysterectomy between June 1, 1987 and June 1, 1992 for the treatment of abnormal uterine bleeding was generated by a computer search of billing records using the appropriate ICD-9-CM codes. The direct cost per case for each patient were defined as the sum of the surgeon's fee, all related hospital and operating room charges, the anesthesiologist's fee, and the cost of preoperative medications. When the initial procedure failed, the cost associated with any additional surgery was accounted for in the determination of the direct cost per case. Indirect costs per case were calculated based on known demographic data, recovery time, and the cost in lost productivity during recuperation. Mean direct and indirect costs per case were determined for each procedure and compared. The mean direct cost per case for endometrial ablation was $5,159 and for myomectomy and ablation was $5,525. The direct cost per case was not different between the hysteroscopic procedures but both were significantly less expensive than either vaginal ($8,132) or abdominal ($8,833) hysterectomy. Total hospital cost also was significantly less for the hysteroscopic procedures than for hysterectomy by either technique. The indirect costs associated with the hysteroscopic procedures were significantly less than those incurred by abdominal and vaginal hysterectomy. The total direct and indirect cost per case of an hysteroscopic approach to the treatment of abnormal uterine bleeding is significantly less than that associated with vaginal or abdominal hysterectomy. This difference persists when the cost of failure of an hysteroscopic procedure is accounted for.

Sustained benefits of leuprolide acetate with or without subsequent medroxyprogesterone acetate in the nonsurgical management of leiomyomata uteri

To determine the effectiveness of leuprolide acetate (LA) followed by medroxyprogesterone acetate (MPA) in the treatment of abnormal uterine bleeding attributed to leiomyomata uteri. Randomized, double-blinded, controlled clinical trial. Human volunteers in an academic research environment. Premenopausal women with abnormal uterine bleeding attributed to leiomyomata uteri. Subjects received 6 months of LA after which they were randomized to receive MPA or placebo. Control of bleeding as assessed by menstrual calendar and self-report; hematologic parameters (hemoglobin and ferritin); uterine size by ultrasonography. More than three quarters of subjects became amenorrheic on LA. The proportion of subjects with improvement in the bleeding abnormality after therapy was not different in the group receiving MPA compared with placebo; however, women who received MPA were less likely to be anemic after therapy than women receiving placebo. Among the women assigned to placebo, 55% experienced an improvement in bleeding compared with pre-GnRH agonist therapy that persisted after discontinuation of LA. There was a high dropout rate (51%), largely associated with failure of the regimens to control bleeding symptoms. Approximately one half of women with abnormal bleeding attributed to leiomyomata uteri have sustained symptomatic improvement after 6 months of therapy with LA even when only placebo therapy is given, although MPA decreases the incidence of anemia. Leuprolide acetate with or without subsequent progestin may be useful as a component of nonsurgical management of these tumors, with monitoring of hematologic status. The interpretability of these data is limited by the high rate of therapy discontinuation in women with abnormal bleeding of the severity studied here.

Treatment of abnormal uterine bleeding with gonadotropin-releasing hormone analogues.

Treatment of abnormal uterine bleeding with gonadotropin-releasing hormone analogues.

Hysteroscopy: An evolving case of minimally invasive therapy in gynaecology

Hysteroscopy is an endoscopic technique, allowing inspection of the intrauterine cavity. Diagnostic applications of the technique began to develop in the 1970s. Although it is often claimed that diagnosis under direct visualization is better than standard dilatation and curettage, it has not yet been proved that hysteroscopic diagnosis has better results than curettage. The clinical application of therapeutic hysteroscopy, mainly in the field of the treatment of abnormal uterine bleeding, started in the 1980s. Two thousand patients have been treated with either hysteroscopic myomectomy, endometrial resection, or endometrial laser ablation, according to the literature. No randomized trials have been conducted. The first clinical results of hysteroscopic treatment seem satisfactory, with average success rates of 85%. There is some evidence that the therapy is cost saving, because hysteroscopic procedures only require one or two nights in hospital. The technique is not yet widely diffused, mainly because of technical difficulties and lack of definite evidence on its effectiveness.

Hormonal inhibition of the endometrium for resectoscopic endometrial ablation

Attempts at inhibiting the thickness and vascularity of the endometrium in preparation for endometrial ablation by using different types of hormones have been reported. To evaluate the effects of two different progestins, danazol, and leuprolide acetate on the endometrium, compared with the features of early proliferative endometrium, histologic studies were done for at least five patients treated with each hormone who then underwent resectoscopic endometrial ablation for treatment of abnormal uterine bleeding. Significant and at times dramatic differences among the treatment groups were found, with progestin-prepared endometrium being the least successful and leuprolide-prepared endometrium the most successful. In addition, the prolonged suppression provided for a period of time after the procedure by depot leuprolide is likely to help inhibit endometrial regeneration and provide even better long-term success of the procedure.

A comparison of vacuum aspiration of the uterus and conventional curettage in the management of abnormal uterine bleeding.

SummaryOutpatient vacuum aspiration of the uterus without anaesthesia was compared with conventional curettage in the diagnosis and treatment of abnormal uterine bleeding. Vacuum aspiration was more effective in producing material for histological examination but was less often practicable than conventional curettage, and was less effective in the investigation of postmenopausal and prolonged bleeding. The apparent therapeutic effectiveness of the two procedures in non‐malignant cases is about equal. The factors limiting the scope of each procedure are discussed.

Adenomyosis: A reappraisal of symptomatology

Adenomyosis is infrequently diagnosed and its symptomatology is not clearly understood by many physicians. This is a curious state of affairs because this disorder is certainly not new. Rokitansky1 first described the condition in 1860. Von Recklinghausen's2 well-publicized article on the clinicopathological features was published in 1896. Cullen's3 unusually complete and now famous 1908 monograph, as well as other more recent studies, 4, 5, 6 has also described the disease exceedingly well. Confusion has developed because of the unfortunate and illogical inclusion of adenomyosis with pelvic endometriosis, which it only occasionally accompanies.7 The clinical findings are often altered by the frequent association of other pelvic abnormalities which are also capable of causing symptoms similar to those of adenomyosis.8For half a century, the manifestations of adenomyosis have been stated to be: progressively severe menstrual bleeding, increasingly painful dysmenorrhea, and a gradually enlarging uterus.3 This concept may be true, but we know of no adequate study which relates adenomyosis to the patient's complaints—after eliminating other associated disorders. Bayly and Yates9 indicated that patients with adenomyosis often bleed from accompanying abnormalities, but only this phase of the problem was considered. It appears that the symptomatology has been largely based upon clinical assumptions and generalizations. Be this as it may, adenomyosis deserves far more consideration than it has received, not only because of its frequency, but also because of the degree of disability which it causes.The purpose of this investigation is: (1) to ascertain the rate of occurrence, extent, and accuracy of diagnosis of adenomyosis in a private general hospital; (2) to demonstrate how adenomyosis and concomitant significant abnormalities effect the patient; and (3) to show adenomyosis as a clinical problem exclusive of coexisting disorders capable of producing similar symptoms. Such a reappraisal should aid in earlier and more accurate diagnosis, as well as better treatment of abnormal uterine bleeding and pelvic pain.

The Treatment of Abnormal Uterine Bleeding with Androgens: Therapeutic Evaluation of Testosterone Propionate, Methyl Testosterone, Ethinyl Testosterone and Androgen Implantation

The Treatment of Abnormal Uterine Bleeding with Androgens: Therapeutic Evaluation of Testosterone Propionate, Methyl Testosterone, Ethinyl Testosterone and Androgen Implantation

Prolan in the Treatment of Abnormal Uterine Bleeding

Prolan in the Treatment of Abnormal Uterine Bleeding