Abnormal uterine bleeding

Cheong, Ying; Cameron, Iain; Critchley, Hilary

doi:10.1093/bmb/ldz008

Cited by 7 publications

(7 citation statements)

References 35 publications

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“…They could signal inadequate progesterone production 41 , which could be caused by thyroid or ovarian dysfunction [41][42][43][44] . There are also structural causes of menstrual abnormalities, including fibroids, polyps, or other uterine anomalies [45][46][47] . Depending on the clinical workup that RPL patients receive, some of them may have undiagnosed hormonal or structural abnormalities, but present as abnormal menses.…”

Section: Discussionmentioning

confidence: 99%

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Sirota

Roger

Xie

et al. 2023

Preprint

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Recurrent pregnancy loss (RPL), defined as 2 or more pregnancy losses, affects 5-6% of ever-pregnant individuals. Approximately half of these cases have no identifiable explanation. To generate hypotheses about RPL etiologies, we implemented a case-control study comparing the history of over 1,600 diagnoses between RPL and live-birth patients, leveraging the University of California San Francisco (UCSF) and Stanford University electronic health record databases. In total, our study included 8,496 RPL (UCSF: 3,840, Stanford: 4,656) and 53,278 Control (UCSF: 17,259, Stanford: 36,019) patients. Menstrual abnormalities and infertility-associated diagnoses were significantly positively associated with RPL in both medical centers. Age-stratified analysis revealed that the majority of RPL-associated diagnoses had higher odds ratios for patients <35 compared with 35+ patients. While Stanford results were sensitive to control for healthcare utilization, UCSF results were stable across analyses with and without utilization. Intersecting significant results between medical centers was an effective filter to identify associations that are robust across center-specific utilization patterns.

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Section: Discussionmentioning

confidence: 99%

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Sirota

Roger

Xie

et al. 2023

Preprint

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“…Current intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used [1]. They have a wide range of applicability in clinical contexts including; nutritional deficiency, malabsorption, disorders associated with chronic blood loss, and chronic inflammatory conditions [2][3][4][5]. The availability of modern preparations allows rapid iron repletion in just one or two doses facilitating ease of treatment [6,7].…”

Section: Introductionmentioning

confidence: 99%

Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice

et al. 2021

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Iron deficiency is a common cause of morbidity and can arise as a consequence or complication from many diseases. The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration. Modern intravenous iron preparations can facilitate rapid iron repletion in one or two doses, both for absolute iron deficiency and, in the presence of inflammation, functional iron deficiency, where oral iron therapy is ineffective or has not worked. A multidisciplinary team of experts experienced in iron deficiency undertook a consensus review to support healthcare professionals with practical advice on managing iron deficiency in gastrointestinal, renal and cardiac disease, as well as; pregnancy, heavy menstrual bleeding, and surgery. We explain how intravenous iron may work where oral iron has not. We provide context on how and when intravenous iron should be administered, and informed opinion on potential benefits balanced with potential side-effects. We propose how intravenous iron side-effects can be anticipated in terms of what they may be and when they may occur. The aim of this consensus is to provide a practical basis for educating and preparing staff and patients on when and how iron infusions can be administered safely and efficiently. KEY MESSAGES Iron deficiency treatment selection is driven by several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of sideeffects or intolerance. Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used, and therefore have applicability in a wide range of clinical contexts, including chronic inflammatory conditions, perioperative settings, and disorders associated with chronic blood loss. Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently.

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“…1 Several conservative therapies are available for the treatment of HMB such as insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) or endometrial ablation/resection (EA). 2 LNG-IUS is both a hormonal contraceptive and an effective treatment for HMB. 3 It induces atrophy of the endometrial tissue resulting in reduced menstrual bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…Heavy menstrual bleeding (HMB) is a gynecological condition defined as abnormal heavy or prolonged bleeding during menstruation with a prevalence of 10%–30% in women of reproductive age 1 . Several conservative therapies are available for the treatment of HMB such as insertion of a levonorgestrel‐releasing intrauterine system (LNG‐IUS) or endometrial ablation/resection (EA) 2 …”

Section: Introductionmentioning

confidence: 99%

The combined use of endometrial ablation or resection and levonorgestrel‐releasing intrauterine system in women with heavy menstrual bleeding: A systematic review

Oderkerk

Kar

Zanden

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Despite endometrial ablation/resection being a very successful treatment for women with heavy menstrual bleeding, re-intervention with additional surgery is needed in 12%-25% of cases. Introducing a levonorgestrel-intrauterine system (LNG-IUS) immediately after ablation could preserve the integrity of the uterine cavity and suppress the regenerated or non-ablated endometrial tissue. Therefore, this combined treatment can perhaps lower the re-intervention rate. The aim of this systematic review was to assess the impact of the combined treatment. Material and methods:The MEDLINE, EMBASE, and Cochrane library were systematically searched. No language restrictions were applied. All types of studies were included reporting on the results of endometrial ablation or resection combined with immediate insertion of LNG-IUS for treatment of heavy menstrual bleeding. The primary outcome was the number of hysterectomies after the ablation procedure.Secondary outcomes included re-intervention rates, removals of LNG-IUS, bleeding pattern, patient satisfaction, adverse effects, and complications. Our protocol was registered in PROSPERO, an international prospective register of systematic reviews under registration number CRD42020151384.Results: Six studies with a retrospective design and one case series with a followup duration varying from 6 to 55 months were included. In total, 427 women were treated with the combined treatment. The studies described a lower hysterectomy and re-intervention rate after combined treatment compared with treatment with endometrial ablation/resection alone. Hysterectomy rate varied from 0% to 11% after combined treatment compared with 9.4% to 24% after endometrial ablation/resection alone. Bleeding patterns and patient satisfaction appeared to be in favor of the combined treatment group. No intra-or post-operative complications or complications in the removal of LNG-IUS were described. The most reported adverse effects after combined treatment were weight gain, mood changes, and headaches. An additional S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Oderkerk TJ, van de Kar MMA, van der Zanden CHM, Geomini PMAJ, Herman MC, Bongers MY. The combined use of endometrial ablation or resection and levonorgestrel-releasing intrauterine system in women with heavy menstrual bleeding: A systematic review. Acta Obstet

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Abnormal uterine bleeding

Cited by 7 publications

References 35 publications

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice

The combined use of endometrial ablation or resection and levonorgestrel‐releasing intrauterine system in women with heavy menstrual bleeding: A systematic review

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