Long-term outcome of hysteroscopic endometrial resection with or without myomectomy in patients with menorrhagia

Objectives  To evaluate the long-term outcomes and hysterectomy rates after hysteroscopic endometrial resection with or without myomectomy for menorrhagia. Study design  Fifty-three women who had submucous myomas with intramural extension of less than 50% and smaller than 5 cm in diameter underwent endometrial resection and concomitant hysteroscopic myomectomy. Each of them was matched with a patient who had no submucous myomas and who had been treated by endometrial resection only. These two groups were compared for operative outcomes, additional procedures, outcome of menstrual bleeding and for subsequent hysterectomy, which was the endpoint of this study. Results  During the mean follow-up period of 6.5 years, 18 (34.6%) women with endometrial resection and myomectomy and 21 (39.6%) without myomectomy underwent at least one gynecological procedure. Hysterectomy was performed in 26.9% [95% confidence interval (CI) 16.8–40.3] of the patients with myomectomy and in 17.0% (95% CI 9.2–29.2) of the patients without myomectomy (P = 0.22). The main indications for hysterectomy were pain and spotting bleeding in seven out of 14 cases with myomectomy and in four out of nine with endometrial resection only. Leiomyomas were found in 12 out of the 14 women who had hysterectomy after hysteroscopic myomectomy and in four out of nine with hysterectomy after endometrial resection only (P = 0.06). Most (75.6%) of the 82 women who had not required hysterectomy had reached menopause. All the patients without hysterectomy in both groups reported amenorrhea or slight bleeding, and this response maintained for years after the treatment. Conclusion  Endometrial resection may be combined with hysteroscopic myomectomy without a significant increase or decrease in hysterectomy rates during a long-term follow-up.     

Second generation endometrial ablation techniques: an audit of clinical practice

Objective(s)  To audit the practice and effectiveness of second generation endometrial ablation techniques (microwave and thermal balloon ablation). Design and methods  An audit of microwave and balloon endometrial ablation procedures was completed and performed during a 2-year period, in two district hospitals of Calderdale and Huddersfield NHS Trust, UK. Patients were followed up with for a maximum of 1 year postoperatively, or were referred again from their GPs, with symptoms. A questionnaire was also completed to evaluate patient satisfaction. Results  About 136 and 59 women underwent balloon and microwave endometrial ablation, respectively (Total = 195), for heavy periods. By the end of year 1, 16% of patients were amenorrhoeic and 60% had lighter periods. About 15% of women did not have any relief of symptoms and needed a hysterectomy by 3 years. There were no statistically significant differences in the endometrial ablation techniques. There was no significant effect of age, body mass index, utero-cervical length, or the ablation technique on the results or the hysterectomy rates. A satisfaction survey showed that 75% of women felt better after the procedure and would recommend it to a close friend. Conclusions  Second generation ablation techniques are safe and effective methods of treating dysfunctional uterine bleeding, and are easy to use. They have reduced the incidence of hysterectomies and also have financial implications for healthcare providers.     

An Open-Label,Single-Arm,Efficacy Study of Tranexamic Acid in Adolescents with Heavy Menstrual Bleeding

Study ObjectiveHeavy menstrual bleeding (HMB) occurs in up to 40% of adolescent girls, significantly affecting their daily activities. Identifying alternative treatment strategies for HMB is particularly important for adolescents who prefer not to take hormonal contraception. Our objective was to determine whether use of tranexamic acid (TA) would increase health-related quality of life and decrease menstrual blood loss (MBL) in adolescents with HMB.Design, Setting, Participants, Interventions, and Main Outcome MeasuresIn an open-label, multi-institutional, single-arm, efficacy study, patients 18 years of age or younger with HMB were treated with oral TA 1300 mg 3 times daily during the first 5 days of menses and monitored over the course of 4 menstrual cycles (1 baseline; 3 treatment cycles). Assessment of MBL was performed using the Menorrhagia Impact Questionnaire (MIQ) and the Pictorial Blood Assessment Chart. The MIQ includes Likert scale items, validated to assess the influence of HMB on quality of life. In previous studies, a 1-point decrease or more in score correlated with clinically significant improvement.ResultsThirty-two patients enrolled in the study, and 25 had sufficient follow-up data to be deemed evaluable. The mean age of the participants was 14.7 years (range, 11-18 years). There was an overall improvement in all items of the MIQ, with a greater than 1-point improvement in the MIQ perceived blood loss scale. When using TA, mean Pictorial Blood Assessment Chart score improved by 100 points. There were no medication-related serious adverse events.ConclusionUse of TA in female adolescents with HMB is well tolerated and leads to clinically meaningful reduction in MBL.     

经量过多患者子宫内膜中ADM表达及意义

目的:研究经量过多妇女子宫内膜中肾上腺髓质素(ADM)及其相关受体降钙素受体相关受体(CRLR)表达的变化,探讨其与疾病发生、发展的关系。方法:通过免疫组化、半定量RT-PCR及实时荧光定量RT-PCR等方法,研究经量过多组患者(n=18)与健康对照组妇女(n=22)ADM、CRLR在子宫内膜中蛋白表达和基因表达量的差异。结果:两组内膜中ADM蛋白表达出现在内膜的各细胞中,经量过多组子宫内膜间质细胞中ADM蛋白表达明显低于正常对照组(P0.05);CRLR蛋白在内膜腺上皮细胞中表达明显高于对照组(P=0.008);经量过多组内膜中血管密度值为1.12(0.8～2.2),明显低于正常组的2.3(0.6～3.6)(P0.05);经量过多组ADMmRNA比正常对照组低25.6%,而两组CRLR mRNA无明显差异。结论:ADM及其受体CRLR在正常子宫内膜生成、修复中发挥重要作用,其影响更多的作用于内膜血管生成;经量过多患者低调控ADMmRNA导致内膜中ADM蛋白表达降低,进一步影响内膜中血管生成和修复,是造成患者出血的原因之一。     

Oral versus rectal misoprostol in the treatment of menorrhagia

IntroductionExcessive menstrual loss is a major problem. Effective medical treatments exist and may provide an alternative to surgery.ObjectiveEvaluation of the effects of oral and rectal misoprostol in the treatment of excessive blood loss in cases of menorrhagia and comparison between both routes.Subjects and methodsSixty patients with heavy, but however, regular periods (menorrhagia) were included in the study. They were randomly divided into two equal groups. Both groups were evaluated in two consecutive menstrual cycles. First without the treatment (baseline value) and the second cycle by either rectal misoprostol tablets (three times daily for the first 3days of the bleeding) or by oral misoprostol tablets (one tablet three times daily for the first 3days of the bleeding). For both the groups the estimated menstrual blood loss was assessed before and after treatment using subjective and objective assessments.ResultsA highly statistical significant reduction in menstrual blood loss occurred by treatments in both groups (p=0.000). Rectal misoprostol produced the highest reduction in the menstrual blood loss with a percent change of 53.45%, while oral misoprostol was less effective in reducing the menstrual blood loss with a percent change of 36.15%. Both routes were effective in improving dysmenorrhea and reducing the number of cycle days with no significant differences between them.ConclusionsBoth rectal and oral misoprostol are safe and effective routes for reducing excessive menstrual blood loss (menorrhagia), but the rectal route is more effective.     

宫腔镜子宫内膜去除术的沿革、现状及前景

子宫异常出血(abnormal uterine bleeding,AUB)是女性的常见病,子宫内膜去除术(endometrial ablation,EA)是其治疗手段之一。EA通过物理或化学方法破坏或切除子宫内膜全层及其下方的浅肌层组织,防止子宫内膜再生,使月经量减少甚至闭经,从而控制过量的子宫出血。EA发展至今,经历了第一代和第二代;每一代EA有许多种通过破坏子宫内膜治疗月经过多的方法。尽管EA越来越安全、有效,但仍有不足之处,如术后再次出血、感染、妊娠;月经相关的疼痛,如宫腔积血、子宫内膜去除-输卵管绝育综合征(post-ablation-tubal sterilization syndrome,PATSS);EA后仍存在子宫内膜恶性疾病的风险。关于EA的许多问题尚需进一步的研究和循证医学的总结。     

宫腔镜下滚球电极去除子宫内膜治疗月经过多合并严重内科疾病35例临床分析

目的探讨宫腔镜下滚球电极去除子宫内膜治疗月经过多合并严重内科疾病的疗效。方法收集2010年10月至2012年6月孝感市中心医院收治的因月经过多合并严重内科疾病行宫腔镜滚球电极电凝去除子宫内膜治疗的患者共35例,观察手术情况及术后疗效。结果所有患者手术顺利,合并的内科病情无加重,随访1年,月经改善有效率为97%,贫血纠正率为100%。结论宫腔镜下滚球电极去除子宫内膜治疗月经过多操作相对简单、安全,临床效果显著,对月经过多合并严重内科疾病患者具有重要的临床应用价值。     

Prevalence of Menstrual Problems among Adolescent School Girls in Rural Tamil Nadu

Study ObjectiveAdolescent girls face a gamut of problems of which the menstrual problems are the most common. Because menstrual problems are subtle, the problems often are unreported. The objective of this study was to estimate the prevalence of menstrual problems, namely dysmenorrhea, menorrhagia, and irregular menstrual cycles.DesignCross sectional study.SettingSchool-based study conducted in a rural school of the Thiruvallur district, Tamil Nadu.ParticipantsThe participants were adolescent girls who attained menarche at least 1 year before the data collection period were selected using a simple random sampling method. A total of 350 participants were included in the study.InterventionsNo interventions were done. A structured, pretested questionnaire was used to collect data.Main Outcome MeasuresThe main outcome measured in this study was the prevalence of menstrual problems, namely dysmenorrhea, menorrhagia, and irregular menstrual cycles.ResultsThe mean age of the study participants was 14.74 years. The mean age at menarche was 12.4 years. In this study, 87.7% of the girls suffered from a menstrual problem. Overall, dysmenorrhea was prevalent in 72.6%, and menorrhagia and irregular menstrual cycles were present among 45.7% and 31.7% of the participants, respectively.ConclusionMenstrual problems form an important domain of adolescent health and because these problems go unreported, it is necessary that adequate attention and care is provided. The consequences of the neglect of menstrual problems results in impaired reproductive and sexual health in older women.     

The use of a biological preparation in the treatment of some gynaecological diseases

Summary

A double-blind between-patient trial was carried out in 200 women suffering from dysfunctional menorrhagia (142) or from menorrhagia associated with uterine fibro-myomatosis (58) to assess and compare the effectiveness of a polypeptide preparation ('Lysometra') and methylandrostendiol in reducing hyperoestrogenism and clinical symptoms. Three 20-day courses of intramuscular injections of either 2.5 ml ‘Lysometra’ or 5 mg methylandrostendiol were given to matched pairs of patients, with an 8-day interval between. Results, as assessed by absolute and percentage changes in total urine oestrogen levels and by overall clinical response of patients, showed that ‘Lysometra’ produced a statistically significant greater effect than methylandrostendiol. The biological preparation was well tolerated and no unwanted side-effects were reported.