Uterine Bleeding Symptoms Research Articles

Endometrial microbiota alteration in female patients with endometrial polyps based on 16S rRNA gene sequencing analysis.

The potential role of the endometrial microbiota in the pathogenesis of endometrial polyps (EPs) warrants further investigation, given the current landscape of limited and inconclusive research findings. We aimed to explore the microecological characteristics of the uterine cavity in patients with EPs and investigate the potential of endometrial microbiota species as novel biomarkers for identifying EPs. Endometrial samples were collected from 225 patients who underwent hysteroscopies, of whom 167 had EPs, whereas 58 had non- hyperproliferative endometrium status. The endometrial microbiota was assessed using 16S rRNA gene sequencing. We characterized the endometrial microbiota and identified microbial biomarkers for predicting EPs. The endometrial microbial diversity and composition were significantly different between the EP and control groups. Predictive functional analyses of the endometrial microbiota demonstrated significant alterations in pathways involved in sphingolipid metabolism, steroid hormone biosynthesis, and apoptosis between the two groups. Moreover, a classification model based on endometrial microbial ASV-based biomarkers along with the presence of abnormal uterine bleeding symptoms achieved powerful classification potential in identifying EPs in both the discovery and validation cohorts. Our study indicates a potential association between altered endometrial microbiota and EPs. Endometrial microbiota-based biomarkers may prove valuable for the diagnosis of EPs. Chinese Clinical Trial Registry (ChiCTR2100052746).

A Prediction Model for the Efficacy of Transvaginal Repair in Patients With Cesarean Scar Defect: An Evidence-Based Proposal for Patient Selection

To establish a prediction model to help doctors determine which patients with cesarean scar defect are more suitable for transvaginal repair. Retrospective analysis. Xinhua Hospital and Shanghai First Maternity & Infant Hospital between June 2014 and May 2021. 1015 women who underwent transvaginal repair of cesarean scar defect (CSD). All enrolled patients underwent CSD repair performed by the same gynecologist and his team. And followed up a clinic visit at 6 months to record their menstruation and measure multiple parameters of the CSD by Magnetic Resonance Imaging. CSD patients are categorized as optimal healing group when the menstruation duration is no more than 7 days, meanwhile the thickness of residual myometrium is no less than 5.39 mm after vaginal repair. The final nomogram is constructed to predict surgical outcomes based on preoperative variables. The key factors that determine optimal healing are the timing of cesarean section (elective or emergency), menstrual cycle, CSD length, width, depth, and the thickness of the lower uterine segment. With the prediction model, scores are given to each parameter according to the statistics. Total scores range from 0 to 25 points, with a cutoff point of 16.5. When a score is greater than 16.5, the transvaginal repair can achieve optimal healing. Uterine position (anteflexion or retroflexion) and preoperative thickness of residual myometrium are the key factors affecting postoperative thickness of residual myometrium. The width of the CSD and the thickness of the lower uterine segment are the key factors affecting abnormal uterine bleeding symptoms (p < 0.01). For the first time, we established a prediction model system that may predict the repair effect of CSD and can potentially be useful in future clinical trials to determine which patients are more suitable for surgery or other treatment options.

Histopathologic study of endometrium in cases of abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common presenting symptoms among women visiting the gynecology outpatient department. Sonography and endometrial biopsy are the usual methods of evaluation; rarely, invasive procedures like hysteroscopy may be needed. Endometrial sampling can be used as a first step in the evaluation. This study was done to analyze the histopathology of the endometrium and to evaluate the causes of abnormal uterine bleeding. Materials and Methods: Endometrial samples were obtained using dilation and curettage from 50 women presenting to the gynaecology outpatient department with abnormal uterine bleeding symptoms in a medical college hospital. Results: Among the 50 cases, 21 were found to have endometrial hyperplasia (72.4%); 24 were diagnosed to have an organic lesion (48%). The endometrium was found to be in the proliferative phase in the majority of the cases (40%). The most common age group was 31-40 years and simple cystic hyperplasia was the commonest endometrial pattern. Single-parity women were most commonly affected and they showed a secretory endometrium under microscopy. Conclusions: Endometrial sampling should be carried out in every patient with abnormal uterine bleeding to study the histopathology of the endometrium and to evaluate the causes of the disease.

Disseminated peritoneal leiomyomatosis: two case reports and literature review

Extrauterine leiomyoma is a rare entity and easily missed or misdiagnosed. We report two cases of disseminated peritoneal leiomyomatosis. The first case was a 42-year-old female presented with uterine bleeding symptoms. Diffuse peritoneal leiomyomatosis was discovered incidentally during surgical removal of uterine leiomyoma. The second case was a 43-year-old female who was misdiagnosed as an abdominal carcinomatosis on ultrasound and MRI. Both cases underwent surgical resection of diffuse smooth muscle tumours on the peritoneum.

Enhanced myometrial vascularity: case presentation and review

To describe the etiology of arteriovenous malformations (AVM) and enhanced myometrial vascularity (EMV), and review updates in management for patients with retained products of conception (RPOC) associated with EMV through a case presentation. A 6-minute narrated video discusses the recent distinction between EMV and AVM. The etiology, symptoms, imaging findings/interpretation, and management based on symptoms are reviewed in detail. As this represents a single case report, it does not meet the definition of research according to the regulations at 45 CFR 46.102(l); therefore, institutional review board approval was not required. Tertiary referral center. Eight weeks after suction dilation and curettage (D&C) for an incomplete abortion, a 28-year-old gravida 1, para 0 patient presented to an outside facility with RPOC, menorrhagia, and an acute decrease in hemoglobin. After uterine AVM was diagnosed, she was transferred to our facility for further care. After transfer to our center, ultrasound demonstrated RPOC, with prominent internal vasculature containing peak systolic velocity >20 cm/s. A diagnosis of EMV was made. Magnetic resonance imaging confirmed a prominent serpentine vessel at the endometrium and RPOC within the uterine cavity (Fig.1). Due to her anemia, she underwent uterine artery embolization (UAE) followed by suction D&C (Fig.2). Hysteroscopy was performed before and after suction D&C and after curettage, a large vascular bundle was appreciated at the surface of the endometrium. None. The patient presented to the clinic 2 weeks postoperatively with the resolution of abnormal uterine bleeding symptoms and a negative β-human chorionic gonadotropin test. Management of patients with EMV is dependent on the extent of their symptoms. If significant bleeding is present, surgical management is required. Previous reports suggested that patients with EMV and RPOC should undergo UAE before D&C, but more recent studies suggest that D&C may be initiated without UAE, as EMV associated with RPOC may be a normal transient placentation phenomenon and have less risk of hemorrhage than previously suspected. However, in patients with significant preoperative bleeding and/or anemia, we propose that UAE should still be considered. Each patient requires individualized management based on symptoms, signs, imaging, and plans for future fertility. The ideal management of patients with RPOC and EMV remains to be determined.

Endometrial assessment of premenopausal women prior to uterine artery embolization: A cross sectional survey of Interventional Radiologists

Uterine artery/fibroid embolization (UAE/UFE) is a minimally invasive treatment for symptomatic uterine fibroids and/or adenomyosis. The terms menorrhagia, metrorrhagia, and dysfunctional uterine bleeding have been abandoned by the International Federation of Gynaecology and Obstetrics (FIGO) due to confusion surrounding their use; in their place abnormal uterine bleeding (AUB) has been adopted. [1] Munro M.G. Critchley H.O.D. Fraser I.S. Committee tFMD. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018; 143: 393-408 Crossref PubMed Scopus (150) Google Scholar This is an overarching term to describe any symptomatic variation from normal menstruation incorporating prolonged menstrual bleeding (>8 days), heavy menstrual bleeding (HMB), and intermenstrual bleeding. Premenopausal AUB affects up to one third of women during their life and the risk of cancer in those who proceed to endometrial biopsy has been estimated at 0.33% (95% CI 0.23–0.48%), and 0.11% (95% CI 0.04–0.32) in the subset with HMB. [2] Pennant M.E. Mehta R. Moody P. et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017 Feb; 124 ([PubMed PMID: 27766759. Pubmed Central PMCID: PMC5297977. Epub 2016/10/22. eng]): 404-411 Crossref PubMed Scopus (41) Google Scholar

Is it necessary to perform an endometrial sampling prior to hysterectomies for benign conditions

Aim: Hysterectomy is one of the most prevalent surgical intervention in gynecological field. This study concerns the requirement and necessity of an endometrial sampling to exclude an unpredictable uterine malignancy risk before hysterectomy for benign conditions. Methods: This is a retrospective and cross-sectional study involving 307 patients who had hysterectomy for benign conditions between years 2014-2018. Prior to hysterectomy, in 162 cases, an endometrial sampling was performed ahead (biopsy group) and in 145 cases, hysterectomy was performed without obtaining an endometrial sampling earlier on (control group). Pre- and post-surgical pathological evaluation reports were collected and compared between the groups. Results: Features of the patients as mean age, number of previous pregnancies, being at postmenopausal status did not vary significantly between two groups. In the biopsy group, 51.2% of the patients were in the premenopausal period, 40.7% of the patients had postmenopausal bleeding and 52.5% had abnormal uterine bleeding symptoms and these three features were significantly higher than in the control group. In the control group, one case (0.7%) had leiomyosarcoma and another case (0.7%) had endometrial adenocarcinoma. In the biopsy group, endometrial adenocarcinoma was detected in 5 patients (3.1%) as significantly higher than in the control group. Conclusion: If there are no symptoms, clinical and radiological findings suggesting an endometrial malignancy in patients who planned to undergo a hysterectomy for benign conditions, it is unnecessary to perform a routine endometrial biopsy.

Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.

Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.

The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.

The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate. To review, clarify, and, where appropriate, revise the previously publishedsystems. To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.

Clinical effect of three doses of mifepristone on patients with dysfunctional uterine bleeding

Objective To explore the clinical effect of three doses of mifepristone on patients with dysfunctional uterine bleeding. Methods 150 patients with dysfunctional uterine bleeding were chosen, and they were randomly divided into 3 groups, including low dose group (50 patients), middle dose group (50 patients) and high dose group (50 patients). All patients adopted routine treatment.On the basis of this, the low dose group received 6.25mg/d mifepristone, the middle dose group received 12.5mg/d mifepristone, the high dose group received 18.25mg/d mifepristone, continued 6 months.The influence of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E), progesterone (P), volume of uterine and endometrail thickness of patients were observed. Results After treatment, the FSH, LH, E and P levels in the three groups were significantly decreased compared with before treatment (FSH: t=4.406, 5.329, 3.610, LH: t=4.563, 6.134, 4.455, P=0.000, 0.000, 0.000; P=0.000, 0.000, 0.000; E: t=7.173, 6.815, 7.018, P=0.000, 0.000, 0.000; E: t=2.367, 6.315, 4.351, P=0.020, 0.000, 0.000), and the difference were statistically significant (all P 0.05). Compared with the low dose group, E levels in the middle dose group and high dose group significantly decreased(t=3.850, 2.085, P=0.000, 0.004). Before and after treatment, the uterine volume among the three groups had no significant difference (P>0.05). After treatment, the functional uterine bleeding symptoms were significantly relieved in the three groups, the effective rate was 100%.The recurrence rate of the low dose group was 32%, which was significantly higher than 8% and 10% of the middle dose group and high dose group.The amenorrhea rate of the middle dose group and high dose group(6% and 2%) was significantly lower than that of the low dose group (46%). Conclusion The treatment of 12.5mg/d mifepristone is effectively adapted to patients with dysfunctional uterine bleeding. Key words: Mifepristone; Uterine bleeding; Dose-respone relationship, drug

Outpatient versus day-case endometrial ablation using the NovaSure™ impedance-controlled ablative system

The objective of this paper was to assess the feasibility and efficacy of the NovaSure™ endometrial ablation system in the outpatient setting using local anaesthesia and to compare this with the standard day-case procedure under general anaesthesia. A prospective cohort-controlled study was undertaken at a university teaching hospital. The patient cohort was made up of 38 women with heavy menstrual bleeding refractory to medical therapy where endometrial ablation was indicated. Endometrial ablation using the NovaSure™ impedance-controlled ablative system was undertaken to compare outpatient treatment using local cervical anaesthetic (experimental group, n=18) with inpatient treatment under general anaesthesia (control group, n=20). The subjective self-assessment of uterine bleeding symptoms, patient satisfaction and health-related quality of life (HRQL; multi-attribute utility assessment) measures at six months following treatment were noted. Participants were also asked as to whether they would subsequently recommend the treatment, based on their experience. All procedures were successfully accomplished. Completed outcome questionnaires were returned by 17/18 (94%) women treated as outpatients and by 13/20 (65%) as inpatients. Overall, 27/30 (90%) women reported an improvement in menstrual bleeding symptoms, with an amenorrhoea rate of 37% (95% CI 20–56%) and a combined amenorrhoea/spotting rate of 53% (95% CI 34–72%). There was no significant difference between the outpatient and inpatient treatment groups in terms of improvement in menstrual blood loss (94% vs. 84%, P=0.6), amenorrhoea (29% vs. 46%, P=0.5), amenorrhoea/spotting (47% vs. 62%, P=0.5), satisfaction (82% vs. 85%, P=1.0), improvement in HRQL (P=0.3) and treatment setting recommendation (88% vs. 77%, P=0.7). From our results, we conclude that NovaSure™ impedance-controlled endometrial ablation is an effective, safe and feasible treatment for heavy menstrual bleeding in both the outpatient and traditional inpatient settings. A choice of treatment settings should be offered to women suitable for this procedure.

64: Outpatient Versus Day-case Endometrial Ablation Using the NovaSure Impedance Controlled Ablative System

The objective of this paper was to assess the feasibility and efficacy of the NovaSure™ endometrial ablation system in the outpatient setting using local anaesthesia and to compare this with the standard day-case procedure under general anaesthesia. A prospective cohort-controlled study was undertaken at a university teaching hospital. The patient cohort was made up of 38 women with heavy menstrual bleeding refractory to medical therapy where endometrial ablation was indicated. Endometrial ablation using the NovaSure™ impedance-controlled ablative system was undertaken to compare outpatient treatment using local cervical anaesthetic (experimental group, n=18) with inpatient treatment under general anaesthesia (control group, n=20). The subjective self-assessment of uterine bleeding symptoms, patient satisfaction and health-related quality of life (HRQL; multi-attribute utility assessment) measures at six months following treatment were noted. Participants were also asked as to whether they would subsequently recommend the treatment, based on their experience. All procedures were successfully accomplished. Completed outcome questionnaires were returned by 17/18 (94%) women treated as outpatients and by 13/20 (65%) as inpatients. Overall, 27/30 (90%) women reported an improvement in menstrual bleeding symptoms, with an amenorrhoea rate of 37% (95% CI 20–56%) and a combined amenorrhoea/spotting rate of 53% (95% CI 34–72%). There was no significant difference between the outpatient and inpatient treatment groups in terms of improvement in menstrual blood loss (94% vs. 84%, P=0.6), amenorrhoea (29% vs. 46%, P=0.5), amenorrhoea/spotting (47% vs. 62%, P=0.5), satisfaction (82% vs. 85%, P=1.0), improvement in HRQL (P=0.3) and treatment setting recommendation (88% vs. 77%, P=0.7). From our results, we conclude that NovaSure™ impedance-controlled endometrial ablation is an effective, safe and feasible treatment for heavy menstrual bleeding in both the outpatient and traditional inpatient settings. A choice of treatment settings should be offered to women suitable for this procedure.

Ambulatory endoscopic treatment of symptomatic benign endometrial polyps: a feasibility study

ABSTRACTObjective To determine the feasibility (potential efficacy and cost‐effectiveness) of ambulatory endoscopic polypectomy in the treatment of symptomatic endometrial polyps.Design Cohort study comparing ambulatory (intervention group) with inpatient treatment (control group).Methods 58 women with symptomatic intrauterine polyps were identified on outpatient hysteroscopy. The experimental group underwent outpatient endoscopic polypectomy using a bipolar intrauterine system (31/58, 53%) and the control group underwent traditional inpatient polypectomy under general anaesthesia (27/58, 47%). The main outcomes compared between the two treatment groups were: uterine bleeding symptoms; patient satisfaction; quality of life (EuroQol); time off work, and use of health service resources at 6 months.Results 18/31 (58%) women treated as outpatients and 16/27 (59%) women treated as inpatients returned completed outcome questionnaires. There was no difference in the effectiveness of outpatient endoscopic polypectomy compared with inpatient treatment, in terms of improvement of abnormal uterine bleeding (11/12 (92%) vs. 13/14 (93%); P = 1.0); patient satisfaction (14/18 (78%) vs. 14/16 (88%); P = 0.7) and quality of life measured by EuroQol (median score 1.0 vs. 0.93; P = 0.1). Patients who underwent inpatient therapy did however, visit their general practitioner more frequently than those who received outpatient therapy (20 visits vs. seven visits, respectively; P = 0.005). The mean cost of outpatient treatment was 37% less than that of inpatient therapy (£490 vs. £781; P = 0.0001).Conclusion Ambulatory endoscopic therapy for symptomatic endometrial polyps appears to be efficacious and cost‐effective. The launch of a randomized controlled trial to confirm these provisional results seems feasible.

Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study

Objective: To determine the feasibility (safety, potential efficacy and cost effectiveness) of a miniature endoscopic bipolar electrosurgical intrauterine system in the treatment of symptomatic submucous fibroids. Study Design: A total of 37 women with symptomatic submucous fibroids were identified on outpatient hysteroscopy. All underwent hysteroscopic excision or ablation using a bipolar intrauterine system (Versapoint™). The main outcomes measures were change in uterine bleeding symptoms measured on a continuous and ordinal scale, patient satisfaction, time of work and use of health service resources at 6 months following treatment. Results: 36/37 (97%) women returned completed outcome questionnaires. The mean amount of abnormal uterine bleeding was reduced at 6 months compared to immediately prior to treatment (P=0.0001). Improvement in bleeding symptoms was reported by 28/36 (78%) women and satisfaction with treatment by 33/36 (92%) women. All procedures were successfully completed, there were no serious operative complications and at 6 months no repeat hysteroscopic procedures were necessary. The mean cost of diagnosis and treatment of submucous fibroids using an endoscopic bipolar intrauterine system was 40% cheaper at 6 months follow-up than a hysterectomy or open myomectomy (£ 1266 versus £ 2123). Conclusion: Hysteroscopic treatment of symptomatic submucous fibroids appears to be safe, efficacious and cost effective. It seems feasible to launch a randomised controlled trial to confirm these provisional results in both the short and longer term.