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Objective: The study objective was to retrospectively evaluate the efficacy and safety of radiofrequency endometrial ablation in treating heavy menstrual bleeding (HMB) in women with chronic renal failure (CRF). Method: Fifty-eight patients with CRF undergoing radiofrequency endometrial ablation in our hospital between January 2013 and July 2017 and for whom complete follow-up data were available were included. Outcome measures included amenorrhea, treatment failure and operative complications. Results: The mean patient age was 41.4 ± 7.7 years, the mean preoperative hemoglobin level was 69.6 ± 19.3 g/dL, the mean preoperative serum creatinine level was 879.1 ± 415.4 µmol/L, and the mean urea level was 18.2 ± 7.1 mmol/L. The mean treatment time for radiofrequency endometrial ablation was 61.7 ± 18.8 s. The median volume of estimated blood loss during the procedure was 10 mL (a range of 2-50 mL). On average, the study subjects were monitored for 24.4 months (a range of 6-60 months). The average amenorrhea rate was 89.7%. Only 2 (3.4%) patients required additional gynecologic surgery after endometrial ablation. Intra- and postoperative complications were not observed. Conclusion: Radiofrequency endometrial ablation was demonstrated to be safe and effective for the treatment of HMB in women with CRF. [ABSTRACT FROM AUTHOR]

In a previous study it was shown that lower factor XI (FXI) levels in women with heavy menstrual bleeding (HMB). Our aim was to determine the single-nucleotide variants (SNVs) in the F11 gene in women with HMB. In addition, an extensive literature search was performed to determine the clinical significance of each SNV. Patients referred for HMB (PBAC-score >100) were included. With direct sequencing analysis of all 15 exons and flanking introns of the F11 gene, 29 different non-structural SNVs were detected in 49 patients with HMB. Interestingly, most of these SNVs have previously been associated with venous thrombosis instead of bleeding. These findings have not helped to elucidate the molecular basis of HMB. They also question the specificity of previously reported F11 variations in patients with thrombosis. More studies are needed to explain the lower FXI levels seen in patients with HMB. IMPACT STATEMENT Women with mild deficiencies of factor XI (FXI) (< 70%) are prone to excessive bleeding during menstruation. Bleeding manifestations are not well correlated with plasma FXI levels and bleeding episodes can vary widely among patients with similar low FXI levels. In a previous study we showed that women with heavy menstrual bleeding (HMB) had normal, but on average, lower levels of FXI than controls. In light of these findings, we performed F11 gene analysis to determine the single-nucleotide variants (SNVs) in women with HMB and performed an extensive literature search to determine the clinical significance of each SNV. By direct sequencing analysis of the F11 gene we found 29 different non-structural SNVs in 49 women with heavy menstrual bleeding. Remarkably, a number of these SNVs have previously been implicated in thrombosis. These findings have not helped to elucidate the molecular basis of lower FXI levels in HMB. They also question the specificity of previously reported F11 variations in patients with thrombosis. More studies are needed to explain the lower FXI levels seen in patients with HMB. [ABSTRACT FROM AUTHOR]

The article discusses the ethical aspects of performing hysterectomy on an intellectually disabled patient in order to prevent painful and lengthy menstruation.

Objective: This review provides an overview of therapeutic options, with a specific focus on the emerging role of medical options for UF management. Research design and methods: PubMed, Google Scholar, and Cochrane Systematic Reviews were searched for articles published between1980 and 2013. Relevant articles were identified using the following terms: ‘uterine fibroids’, ‘leiomyoma’, ‘heavy menstrual bleeding’, and ‘menorrhagia’. The reference lists of articles identified were also searched for other relevant publications. Results: Because of the largely benign nature of UFs, the most conservative options that minimize morbidity/risk and optimize outcomes should be considered. Watchful waiting, or no immediate intervention combined with regular follow-up, is an appropriate option for the majority of UF patients who experience no symptoms. For women with symptomatic UFs, the optimal treatment should restore quality of life through rapid relief of UF signs and symptoms, reduce tumor size for a sustained period, and maintain or improve fertility. Invasive surgical treatments, such as hysterectomy, have historically been the mainstay of UF treatment. Less invasive surgical and interventional techniques, such as myomectomy, uterine artery embolization, endometrial ablation, and myolysis provide alternatives to hysterectomy. Until recently, medical management of UFs was characterized by short-term treatments and therapies that provided symptomatic control. In addition to controlling abnormal uterine bleeding, newer medical therapies, including the recently Health-Canada-approved ulipristal acetate, act directly to shrink the tumor. Although no agent is currently approved for such use, emerging evidence suggests the potential for long-term medical management of UFs. Conclusions: The advent of novel medical therapies may diminish the long-held reliance on more invasive surgical UF treatment options [ABSTRACT FROM AUTHOR]

The author discusses research on topics related to climacteric and menopause medicine. Topics include the long-term effects of levonorgestrel-releasing intrauterine system (LNG-IUS) compred with hysterectomy for menorrhagia treatment, the use of low-dose aspirin in primary intervention of cardiovascular disease, and the association of hormone replacement therapy (HRT) with increase risk of pancreatitis and cholecystectomy.

Objective To evaluate the effectiveness of the levonorgestrel releasing-intrauterine system (LNG-IUS) in the treatment of menorrhagia and/or frequent irregular uterine bleeding in women with uterine myomas. Study design Prospective study whereby 102 women with intramural myomas (in a few cases associated with submucous or subserous myomas), suffering from menorrhagia and/or frequent irregular uterine bleeding, were evaluated by means of the Pictorial Blood Assessment Chart (PBAC; Higham score) and ultrasound, three, six and 12 months after insertion of a LNG-IUS. Results The PBAC score dropped (from a mean value of 231.7 to 17.6 at 12 months). The duration of menstrual bleeding diminished significantly ( p < 0.001). Uterine volume decreased from a mean of 145 cm³ to 129 cm³ at 12 months ( p == 0.01). Changes in the volume of the myomas were not statistically significant ( p == 0.23). Satisfaction rate was good in 91 cases (89%), fair in four cases (4%), and poor in seven cases (7%). During the one-year period of follow-up, 11 cases of expulsion or removal of the LNG-IUS were recorded. Conclusion The LNG-IUS is effective in controlling heavy menorrhagia and/or frequent irregular uterine bleeding related to the presence of myomas, but has no significant effect on the size of the tumours. [ABSTRACT FROM AUTHOR]

The use of NovaSure under local anaesthesia (LA) has been described as part of efficacy trials, but its use in an outpatient setting has not previously been explored. This prospective study was conducted to determine feasibility and efficacy of NovaSure in the outpatient setting under LA. The study included all women with menorrhagia unresponsive to medical management and were agreeable for treatment under LA ( n == 50). The mean duration of procedure was 100 s. A total of 47 (94%%) patients were discharged home the same day. Simple analgesics controlled postoperative pain in 44 (88%%) patients. Seven (14%%) patients gave preference for general anaesthesia for future treatment. The mean pain scores at 30, 60 and 90 min were 4.18, 4.38 and 3.85, respectively on the visual analogue scale. At follow-up, the improvement in menstrual symptoms was seen in 47 (94%%) and the satisfaction rate was 43 (86%%) and 47 (94%%) at 4 and 6 months, respectively. [ABSTRACT FROM AUTHOR]

Our study investigated the personal experience and satisfaction of patients with menstrual disorders treated with the Mirena intrauterine system in secondary care. A retrospective questionnaire was sent to all 1,100 women treated with a Mirena intrauterine system in the Menstrual Disorders Clinic between 1995-2003 at the Queens' Medical Centre, Nottingham, England. A total of 1,056 (96%) women responded and were included in the study. The majority (73%) of women continued to use the Mirena. The women reported a decrease in the heaviness, frequency and pain associated with their period. The commonest side-effect experienced was spotting (19%). Women ranked their satisfaction on a scale of 1-10, with a mean score of 7.07/10. The majority of women are satisfied with the Mirena as a treatment for menstrual disorders. Less than 5% of the women required subsequent operative treatment for menstrual disorders following treatment with the Mirena. [ABSTRACT FROM AUTHOR]

The purpose of the present audit was to assess the effectiveness and safety of thermal balloon ablation of the endometrium for the treatment of menorrhagia and also to assess patients' satisfaction following the treatment. A total of 50 women successfully underwent endometrial ablation using the Thermachoice balloon system for the treatment of menorrhagia at Caerphilly Miners' District Hospital, Caerphilly, South Wales, UK in the period between September 2000 and December 2002. All cases were performed under a general anaesthetic. There was no equipment failure in this study. No major intra-operative or postoperative complications were noted. However, a post-procedure complication rate of 4% was reported. All cases were discharged within 24 h. Cases were reviewed 3, 6, 12 and 24 months postoperatively. All 50 women attended for follow-up after 3 months. However, two cases were lost for follow-up at 6 months. The number increased to three cases after 12 months and seven cases after 24 months. At each visit, women were interviewed with emphasis on their menstrual history after treatment and the need for further therapy – if any. Women were asked to respond on a four-point ordinal scale to assess satisfaction with treatment (very satisfied, satisfied, dissatisfied or very dissatisfied). Symptomatic improvement was checked by asking participating women to grade the heaviness of their menstrual blood loss as none (amenorrhoea), lighter than before (hypomenorrhoea), or same as before (persistent menorrhagia). Improvement was defined as amenorrhoea or hypomenorrhoea, while procedure failure was defined as persistent menorrhagia. A statistically significant (p = 0.0001) difference was found between pre- and post-treatment heaviness and duration of menstrual flow, as well as the incidence of anaemia. The success rate was maintained over the follow-up period with a range of 86 – 92%. Patient satisfaction was also high at 86%. However, in view of persistent menorrhagia, six patients out of 43 (14%) required further treatment. [ABSTRACT FROM AUTHOR]

This prospective observational study evaluates the efficacy and safety of thermal Balloon endometrial ablation using the Cavaterm system for the treatment of dysfunctional uterine bleeding. Seventy-seven women with a mean age of 43 years who met the inclusion and exclusion criteria were treated under general anaesthesia. A 9-mm diameter catheter with a silicone balloon at its tip was inserted transcervically into the uterus and was inflated with sterile 1.5% glycine and connected to a control unit that maintained the temperature of the circulating heated fluid at 75 degrees C, monitored the pressure and terminated the treatment after 15 minutes. There were no intra-operative complications and patients tolerated the treatment well. Satisfaction rates were 90% at both 12 and 24 months. At 24 months 10% of patients had heavy periods, 5% normal periods, 39% light periods and 46% amenorrhoea. Cavaterm balloon ablation seems a safe and effective option for women with menorrhagia. The procedure does not require additional training and expertise in operative hysteroscopy and compares favourably with established techniques. [ABSTRACT FROM AUTHOR]

Sixteen women requesting surgical treatment of menorrhagia were recruited for a study on microwave endometrial ablation. The mean age at treatment was 41.4 years and all patients had completed their family and were pre-menopausal. Average treatment time was 2 minutes 6 seconds. All patients reported a reduction in their menstrual loss and 87.5% were satisfied with their treatment after 1 year follow-up. One patient required overnight admission for analgesia while 15 patients were treated on a day case basis using light general anaesthesia. Sixty-seven per cent of patients reported a reduction in dysmenorrhoea scores at 1 year, two patients reported no change in symptoms and one patient reported a modest increase. One patient had a hysterectomy 10 months after treatment despite being amenorrhoeic. The indication for hysterectomy was pelvic pain (which was present before endometrial ablation). There were few minor complications but no uterine perforation or emergency hysterectomies. [ABSTRACT FROM AUTHOR]

Between March 1996 and March 1998 236 women had a hysterectomy at Tameside District General Hospital. Of these, women, the indication in 132 was idiopathic menorrhagia and their treatments before hysterectomy were reviewed. It was found that luteal phase progestogens were the drug treatment of choice for menorrhagia by the general practitioners (GPs) and hospital doctors (46% and 40·5%, respectively). Fifty-two (39%) of the women had no medical treatment before hysterectomy while 38 (29%) had only one type of drug treatment. The decision to perform a hysterectomy was taken at the first clinic visit in 40 (30%) of the women and in 77 (58%) of them by the second visit. Transcervical resection of the endometrium (TCRE) was tried in 11% of the women, while none had the levonorgestrel impregnated intrauterine system (Mirena IUS) fitted. Objective assessment of menstrual loss was not performed before treatment. Our data suggest an early recourse to hysterectomy in the treatment of idiopathic menorrhagia and the hypothesis that hysterectomy follows failure of appropriate medical and alternative treatment of menorrhagia was not confirmed. [ABSTRACT FROM AUTHOR]

A randomised study was undertaken comparing danazol 200 mg daily and medroxyprogesterone acetate 10 mg daily from days 16 to 25 in the management of menorrhagia. Twenty-three women were recruited to the study over a 12-month period. Eighteen subjects were suitable for analysis. Three months' therapy was given and patients were observed for a 3-month period following discontinuation of therapy. Menstrual blood loss was estimated during initial patient assessment and then during each of the 6 months of the study. In the danazol group mean blood loss at all treatment phase months was significantly decreased from baseline. In contrast, blood loss was not reduced significantly in any study month when compared with baseline in the medroxyprogesterone acetate group. During the post-treatment phase the mean blood loss in the danazol group increased to above normal levels but remained significantly lower than baseline, and there was a significant reduction in menstrual blood loss in the medroxyprogesterone acetate group. [ABSTRACT FROM AUTHOR]

Second-generation endometrial ablation techniques provide an effective surgical treatment option for women with menorrhagia. Their ease of use might result in inappropriate surgical treatment without previous medical therapy. We sought to establish local compliance with national guidelines following the recent introduction of second generation ablation techniques into routine practice. We collected data at the time of ablation on the preceding medical management of women undergoing either microwave endometrial ablation or thermal balloon ablation. One hundred and thirty-two consecutive women underwent second-generation endometrial ablation. At least one medical treatment (range 1 - 5) was used before ablation in 86% of women. The majority (86%) of women undergoing a second-generation endometrial ablation technique received at least one effective medical therapy before surgical intervention, indicating a high level of compliance with published guidelines. [ABSTRACT FROM AUTHOR]

Discusses the short-term and long-term outcome of management of menorrhagia with a balloon thermo-ablation system. Dependence of the success rate from the balloon thermo-ablation system on the definition of success length of follow-up and patients' satisfaction; Association of mild to moderate postoperative dysmenorrhea.

Reports on the continuous menorrhagia in a woman which does not respond to medical management. Findings of the physical examination; Agreement of the patient to a total abdominal hysterectomy; Treatment of the leiomyomatosis by various surgical procedures.

Thermal balloon ablation (TBA) was introduced by Neuwirth et al. in 1994 for the treatment of menorrhagia. It is thought to be as effective, easier to learn and safer than other endometrial ablation techniques (Vilos et al., 1997; Amso et al., 1998; Meyer et al., 1998). We present our experience of the first 56 patients treated in a district general hospital. As the Thermachoice balloon system (Thermachoice; Gynaecare, Inc., Menlo Park, CA, USA) has a SERNIP B classification, our aim was to ensure that all patients were adequately counselled, treated appropriately and that all relevant documentation was complete. We also reviewed the effectiveness of this procedure through a number of different outcome measures. [ABSTRACT FROM AUTHOR]

studies the treatment of menorrhagia with the levonorgestrel intrauterine system. Association of menorrhagia with uterine fibroids; Factors affecting the success of treatment.

Studies the therapeutic use of thermal balloon endometrial ablation in the treatment of menorrhagia. Details on the uterine balloon therapy system; Materials and methodology of the study; Results of the study; Results of the study; Discussion on the results.

Presents a study on the comparison of endometrial laser oblation (ELA) with transcervical resection of the endometrium in the treatment of menorrhagia. Method used in the study; Results of the study; Conclusions.

Evaluates laser ablation of the endometrium (LAE) in the treatment of menorrhagia using the patients own subjective criteria for response. Methods of the study; Outcome following laser ablation of the endometrium; Discussion.

The article presents a study which examines the efficacy of global endometrial ablation in women with bleeding disorders who presented with menorrhagia. A record-linkage system was used in constructing a retrospective cohort of 41 women with coagulopathies and a reference group of 111 randomly selected women without bleeding disorders. The findings suggest that endometrial ablation may be an effective treatment in women with bleeding disorders.

Reports on the case of severe vaginal scalding as a side effect of MenoTreat treatment, a routine method in Scandinavian countries for ablation of the endometrium in women with menorrhagia. Case of a 43-year-old woman in Denmark severe vaginal bleeding; Performance of the MenoTreat under general anesthesia; Scald lesion in the top of the vagina; Destruction of the endometrium and the cervical canal.

Reports a case of endometrial resectioning in a menorrhagic patient. Signs and symptoms presented by the patient; Pathology of amenorrhagia; Consideration of haematometra in the diagnosis of women with loin pain.