Modified Fixation of Levonorgestrel-releasing Intrauterine System for the Treatment of Adenomyosis / 中山大学学报(医学科学版)

ObjectiveTo introduce a fixation technique with the modified levonorgestrel-releasing intrauterine system （LNG-IUS） and evaluate its efficacy in the treatment of adenomyosis patients with previous LNG-IUS expulsion. MethodsA retrospective analysis was done on 22 adenomyosis patients who underwent modified LNG-IUS fixation due to LNG-IUS expulsion at three hospitals from June 2022 to June 2023. The baseline clinical characteristics， operative and postoperative details were collected and analyzed. The Visual analogu scale （VAS） scores and pictorial blood loss assessment chart （PBAC） scores were measured and compared before， 3 and 6 months after the LNG-IUS fixation. ResultsThe mean operative time was （19.51±7.41） min and intraoperative bleeding was （6.71±5.30） mL. Of the patients， 13 were operated under local anaesthesia and the other 9 under intravenous anaesthesia. There were 4 operations performed by a resident doctor， 15 by an attending doctor and 3 by a senior doctor. No intraoperative or postoperative complication was found. The mean follow-up was 11.51 months and no patient had a recurrence of LNG-IUS expulsion during the follow-up period. The mean level of hemoglobin at 1 month after operation was significantly higher than that before （P<0.001）. VAS scores and PBAC scores at 3 and 6 months postoperatively were all improved significantly than those preoperatively （P<0.001）. ConclusionsEffectively preventing the recurrence of LNG-IUS expulsion， modified LNG-IUS fixation is a safe and efficient method for adenomyosis patients with previous LNG-IUS expulsion. Modified LNG-IUS fixation deserves the clinical application due to its easy operation and wide range of use on women.

Histopathological examination of endometrium in menorrhagia patients

Introduction: Menorrhagia is one of the commonest clinical conditions for which patients seek advice in the gynecological outpatient department. Aim and objectives of study: To determine the prevalence of various histopathological changes, patterns and lesions of endometrium associated with menorrhagia in the women of different age groups; to describe the morphological features of various lesions of endometrium; to assess demographic pattern of various types of endometrium lesions in this part of our country and to do clinicopathological correlation and give diagnosis based on it. Materials and methods: This was a prospective, non-interventional and observational hospital based crosssectional one year study carried out between January 2020 to June 2021 in Histopathology Department of Dhiraj Hospital on 52 cases of D & C and hysterectomy specimens. All the specimens were fixed in 10% formalin were received in the department of Pathology and processed and embedded in paraffin wax. Multiple serial sections of 4-5 microns thickness were obtained from the paraffin block and then stained with H & E. Detailed study of the sections was done by light microscopy. Results: 52 cases of menorrhagia were studied clinically and histopathologically. In present study, large proportion of patients with menorrhagia showed proliferative endometrial pattern (38.46%) followed by secretory phase (34.62%). Hyperplastic pattern was seen in 13.46% of patients. Non hyperplastic endometrial pattern was more common than hyperplastic pattern. Simple hyperplasia was more commonly seen than complex and atypical hyperplasia. Overall incidence of atypical hyperplasia was low (28.57%) and atrophic endometrium seen in 5.7% of cases. Endometrial polyp was seen in 3.84% cases and endometrial carcinoma was seen in 3.84% cases. Conclusion: Histopathological study of endometrium is very useful to reveal different endometrial patterns in menorrhagia and to distinguish between anovulatory and ovulatory causes. It is also useful for the diagnosis of endometrial hyperplasia and endometrial carcinoma.

Abnormal uterine bleeding in reproductive age: a comparative analysis between the five Brazilian geographic regions

SUMMARY OBJECTIVE: This study aimed to comparatively evaluate the presence of abnormal uterine bleeding and associated factors among women from the five official Brazilian geographic regions. METHODS: This is a cross-sectional, population-based, multicenter study of reproductive-age women from the five regions of Brazil. All participants answered questionnaires containing personal and socioeconomic data and information on uterine bleeding (self-perception and objective data). RESULTS: A total of 1,761 Brazilian women were included, 724 from the Southeast, 408 from the Northeast, 221 from the South, 213 from the North, and 195 from the Central-West. Considering women's self-perception, the prevalence of abnormal uterine bleeding was 37.56% in the North region, 39.46% in the Northeast, 21.54% in the Central-West, 29.56% in the Southeast, and 25.34% in the South (p<0.001). Abnormal uterine bleeding was more prevalent in the North and Northeast, where women had lower purchasing power, became pregnant more often, and were the only ones financially responsible for supporting the family more often (p<0.001). The menstrual cycle lasted <24 days in less than 20% of the women in all regions (p=NS). Among these, approximately 8 out of 10 women had never undergone treatment in four out of the five regions evaluated. More than half of the evaluated women reported a worsening of their quality of life during bleeding. CONCLUSION: The prevalence of abnormal uterine bleeding in Brazilian women was higher in the North and Northeast, followed by the Southeast, South, and Central-West regions. There was a worsening of quality of life during menstruation regardless of the woman's self-perception of abnormal uterine bleeding. Such results can direct the actions of health managers toward a better approach to abnormal bleeding.

Comparative study of the levonorgestrel intrauterine system and laparoscopic hysterectomy for the treatment of heavy menstrual bleeding in enlarged uteri

ABSTRACT Objective To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2. Results In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00). Conclusion Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.

Gynaecological Disorders Among Adolescent Girls Attending a Tertiary Care Hospital in South India: a Cross-Sectional Study.

Background: Adolescents in India contribute to 22% of the country’s population and are susceptible to various preventable and treatable health issues. Objectives: To estimate the burden and to describe the pattern of gynaecological disorders among adolescent girls attending the outpatient and inpatient departments of a private medical college hospital in South India. Materials and methods: This was a hospital based cross sectional analytical study done among 500 adolescent girls of 10-19 years age group in a private medical college hospital in South India during December 2020 to December 2021 using a pretested questionnaire. Data was analysed using IBM SPSS version 23. Chisquare test or Fischer exact test was done to find the association between categorical variables. Mann Whitney U test was used to compare the difference between means. P value less than 0.05 was considered to be significant for all comparisons. Results: Mean age of study population was 15.94 ± 2.52 years. Menstrual abnormalities reported in 303 (60.6%) girls followed by 240 (48%) girls had leucorrhoea, 68 (13.6%) had urinary tract infection and 54(10.8%) had PCOS. Conclusion: There is a high burden of gynaecological disorders and lack of awareness on various components of adolescent reproductive and sexual health among adolescents.

Efficacy Of Homeopathic Medicines In Dysmenorrhoea

Background:The study aims to prove the efficacy of Homoeopathic Medicines in Dysmenorrhoea was conducted for 1½ year in the age of 14-45 years. Dysmenorrhoea is commonest complaint in females affecting half of females in the age of 11-45 years. It is one of the leading causes of periodic absentee in colleges and school. It incapacitates women in her day to day life1. It is defined as painful menstruation of uterine origin and is divided in two categories Primary and secondary. Primary begins typically during adolescences and there is no pelvic cause while secondary is uncommon during adolescences and results from pelvic origin. This article focuses on classification, pathology, clinical type and efficacy of homoeopathic medicines. The aim is to give a pain free menstruation to female thus improving quality of life in women. Material And Methods:A total of 20 patient were selected who complained of moderate to severe dysmenorrhoea for 1½ year with holistic approach according to model case proforma. Result:The study shows that in majority of cases there was no major cause for dysmenorrhoea 90% of cases responded well with Homoeopathic medicines where majority cases required PULSATILLA as a constitutional medicine, Mag Phosphoricum as an acute and Tuberculinum as intercurrent remedy. Among these,constitutional medicine acts more effectively.Conclusion:Thus it can be concluded that Homoeopathic medicines prove effective along with change in lifestyle, food habits and distress. Acute exacerbation can be controlled with acute medicines and anti miasmatic are required in stands still conditions. Potency can be 30 or 200 depending on susceptibility.

Endometrial hyperplasia treatment with the levonorgestrel-impregnated intrauterine system or oral progestogens / Шинэ санаа Шинэ нээлт

Background@#To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries.@*Methods@#Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. @*Results@#Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] @*Conclusions@#Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Custo-efetividade e limiar de custo para o uso do sistema intrauterino liberador de levonorgestrel para o tratamento do sangramento uterino anormal sob a perspectiva do Sistema de Saúde Suplementar no Brasil / Cost-effectiveness and cost threshold for the use of levonorgestrel-releasing intrauterine system for treatment of heavy menstrual bleeding from the Supplementary Health System perspective in Brazil

Objetivo: Definir um limiar de custo para o sistema intrauterino liberador de levonorgestrel 52 mg (SIU-LNG 52 mg) para o tratamento do sangramento uterino anormal (SUA) sob a perspectiva do Sistema de Saúde Suplementar brasileiro. Métodos: Foi elaborado um modelo de custo-efetividade para definir o limiar de custo de inserção de SIU-LNG 52 mg em mulheres com SUA em comparação à histerectomia. Um modelo de Markov foi estruturado com ciclos anuais para reproduzir o tratamento do SUA em um e cinco anos, considerando custos médicos diretos e o percentual de histerectomias evitadas como desfecho. O custo da histerectomia foi variado até o valor de 10.000 reais brasileiros (BRL) com incrementos de 500 BRL a cada nova simulação para avaliar o limiar de custo do SIU-LNG 52 mg para igualar o custo total de tratamento de ambas as estratégias analisadas. Resultados: O SIU-LNG 52 mg demonstrou ser uma opção de tratamento dominante quando comparada à histerectomia, levando à redução da frequência de realização do procedimento cirúrgico em 59,62% das mulheres e redução de 2.557,91 BRL no custo total de tratamento em cinco anos. Ao considerar a histerectomia a 6.000 BRL, o custo do procedimento com SIU-LNG 52 mg poderia ser de até 6.150,35 BRL e 3.994,60 BRL para igualar o custo total de tratamento, em horizontes temporais de um e cinco anos, respectivamente. Conclusão: SIU-LNG 52 mg demonstrou ser uma opção dominante para o manejo do SUA, sendo capaz de atrelar economia para o sistema de saúde a benefícios para a mulher perante a cirurgia.

Objective: To define a cost threshold for the use of levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS 52 mg) for the treatment of heavy menstrual bleeding (HMB) in the Brazilian Supplementary Health System perspective. Methods: A cost-effectiveness model was built to define the cost threshold for insertion of LNG-IUS 52 mg considering women with diagnosis of HMB as the target population and hysterectomy as the comparator. A Markov model was structured with annual cycles to reproduce HMB treatment in 1 and 5 years, considering direct medical costs and the percentage of avoided hysterectomies as the outcome. Hysterectomy cost was varied up to 10,000 Brazilian real (BRL) with increments of 500 BRL at each new simulation to define LNG-IUS 52 mg cost threshold, to provide equal total treatment costs for both strategies. Results: LNG-IUS 52 mg proved to be a cost-saving option when compared to hysterectomy, leading to a reduction in the frequency of the surgical procedure by 59.62% and a total treatment cost reduction of 2,557.91 BRL in 5 years. When considering hysterectomy at 6,000 BRL, the cost of the procedure with LNG-IUS 52 mg could be up to 6,150.35 BRL and 3,994.60 BRL to provide equal total treatment cost in 1 and 5 years time horizon, respectively. Conclusion: LNG-IUS 52 mg has proven to be a cost-saving option for the health system in the management of HMB, in addition to the known benefits for women against surgery.

A study of causes, investigation and management of structural causes of abnormal uterine bleeding in reproductive age group

Background: Abnormal uterine bleeding (AUB) is debilitating condition affecting 14-25% of women of reproductive age. It has significant impact on women’s personal, social, physical and quality of life. Present study is planned to study causes, investigation along with management of structural causes of abnormal uterine bleeding in reproductive age group.Methods: Consecutive type of non-probability sampling was used for selection of study subjects. A total of 100 gynaecology OPD women diagnosed with menorrhagia of 15-45 years age group were enrolled in study.Results: Mean age of the study subjects was between 26-35 years (47%). 67% were from low socio-economic class while 33% were from middle class. Maximum number of women (66%) had symptoms for less than 6 months. 47% presented with Menorrhagia. 89% were Multiparous, and 11% were Nulliparous. Most common structural causes of AUB was leiomyoma (41%) followed by polyps (23%), adenomyosis (17%), endometrial hyperplasia (15%) and endometrial carcinoma (4%). Prevalence of anemia was 73% in present study. Maximum leiomyoma were treated medically while higher percentage of polyps and hyperplasia was treated surgically. Most commonly performed surgery was polypectomy (20%) followed by dilatation and curettage (17%) and myomectomy (15%). Total abdominal hysterectomy was done in 8% cases while radical hysterectomy was done in 2% cases.Conclusions: Benign lesions of endometrium account for majority of cases presenting with AUB in reproductive age group. Other premalignant and malignant causes should also be considered. High prevalence of anemia was observed in these cases. A comparative clinicopathological study will help in arriving at the cause and correct diagnosis. Histopathological examination is one of the major tools in evaluation of abnormal uterine bleeding and helps us in proper management and treatment of cases.

Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016 / Seguridad y aceptabilidad del sistema intrauterino liberador de levonorgestrel 52 mg en mujeres con hemorragia uterina anormal en un centro de atención ambulatoria en bogotá, colombia, 2012-2016

RESUMEN Objetivo: describir la seguridad y aceptabilidad del uso del sistema intrauterino liberador de levonorgestrel de 52 mg en mujeres con hemorragia uterina anormal. Materiales y métodos: cohorte retrospectiva en la que se incluyeron mujeres de 18 años o más con diagnóstico de hemorragia uterina anormal, reporte por ultrasonido de tamaño uterino entre 6 y 10 cm de longitud y cavidad endometrial uniforme en toda su longitud, independiente de alteración estructural, a quienes se les colocó para tratamiento el sistema intrauterino liberador de levonorgestrel de 52 mg, en el periodo de 2012 hasta 2016 Se realizó un muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas basales, así como la percepción de la hemorragia por parte de la paciente y la frecuencia de falla, amenorrea, necesidad de histerectomía y eventos adversos, con seguimiento a 12 meses. Se aplicó estadística descriptiva. Resultados: se evaluaron 200 pacientes, hubo una percepción de mejoría subjetiva del volumen de sangrado y de la frecuencia de incapacidad laboral o asistencia a urgencias. El 90 % de las pacientes registró amenorrea y el 6 % eventos adversos. Conclusiones: el sistema intrauterino liberador de levonorgestrel de 52 mg es una alternativa segura para el manejo de la hemorragia uterina anormal en mujeres con úteros de tamaño normal y sin alteraciones submucosas del endometrio. Se requieren estudios aleatorizados en el medio local para evaluar su efectividad y eficiencia respecto a otras alternativas de manejo.

ABSTRACT Objective: To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. Materials and methods: Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. Results: Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. Conclusions: The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.

A rare case of symplastic leiomyoma: case report

Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. Atypical and bizarre leiomyoma synonymous with symplastic leiomyoma are rare smooth muscle tumors that contain cells with moderate to severe cytological atypia, still cell necrosis is absent and mitotic index is fewer than 10/10 HPF. A 42-year P1L1A3 with no comorbidities came with complaints of lower abdominal pain for one year and heavy menstrual bleeding for eight months, LMP- 15/2/19, regular cycles, changes 4-5 pads/day, clots (+) (+), dysmenorrhoea (+). Parity score of P1L1A3, LCB-24 years, not sterilized. On examination - moderately built and nourished, pallor (+). Per abdomen examination - uterus - 22 weeks size, irregular mass, arising from pelvis - no tenderness, lower border not made out. Per speculum examination - cervix and vagina healthy. Per vagina examination - cervix firm, posterior, left fornix: mass felt, non-tender. The patient underwent Abdominal hysterectomy and B/L salpingo-oophorectomy under CSEA. Intraoperative findings - uterus - 20 weeks size, enlarged, a posterior wall subserosal fibroid with degeneration of 6×8 cm. Microscopic appearance - uterus - myometrium shows changes in adenomyosis. Sections of smaller mass reveal structure of leiomyoma. Nuclei are large, hyperchromatic, and show coarse chromatin clumps. Many giant-sized cells with multiple large nuclei were seen. It showed large chromatin clumps. Stroma showed myxoid change. Diagnosis - symplastic leiomyoma, adenomyosis. Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. The regularity of the tumor margins, low mitotic activity, and absence of nuclear atypia or necrosis should be made for the exclusion of malignancy.

A study of prevalence of thyroid dysfunction in abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is one of the most frequent presentation to gynecology OPD. AUB is a common but complicated clinical presentation and occurs in 15-20% of women between menarche to menopause and significantly affects the women’s health. Thyroid disorders are more common in women than in men and cause abnormal sexual development, menstrual irregularity, infertility and premature menopause. Objective of this study was to estimate the prevalence of thyroid disorders in women in reproductive age group with AUB.Methods: A hospital based prospective cross sectional observational study was carried out in department of obstetrics and gynecology, Mazumdar-Shaw Cancer and Medical Center and Narayana Hrudayalaya Hospital at Narayana Health City, Bangalore with abnormal uterine bleeding during the period of 2 years (December 2015 to November 2017), total 153 patients were included in the study. All women with AUB in reproductive age group were included. Diagnosed cases of ovarian cyst, uterine fibroid, polyp, adenomyosis, endometriosis and malignant (endometrial and cervical) tumors were excluded. Women who are on drugs or hormone therapy (for past 3 months. IUCD users/oral contraceptives pill user. Patients with known case of thyroid disorder, carcinoma thyroid patients with history of coagulation disorder, liver disorder, renal disorder, tuberculosis.Results: A total N=115 (75.2%) of patients who took part in this study had euthyroid status. The estimated prevalence of thyroid dysfunction was 24.9%. Out of which n=22 (14.4%) had subclinical hypothyroidism, n=14 (9.2%) had overt hypothyroidism, n=2 (1.3%) had hyperthyroidism. The most common thyroid dysfunction amongst the study group was noted to be subclinical hypothyroidism (14.4%).Conclusions: There is a high prevalence of thyroid disorders in cases which are clinically diagnosed as AUB. TSH is most sensitive test in detecting thyroid dysfunction. Subclinical cases need to be treated. Hence thyroid function evaluation should be made mandatory in cases of AUB to detect thyroid dysfunction.

Abnormal uterine bleeding in perimenopausal women: sonographic and histopathological correlation and evaluation of uterine endometrium

Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.

A comparative study of hysteroscopy and transvaginal ultrasonography in diagnosis of endometrial pathology in abnormal uterine bleeding

Background: Abnormal uterine bleeding is the most common complaint in gynaecology and an important source of morbidity. The ideal diagnostic tool to determine the cause for the same continues to be debated. Objective of this study was to compare accuracy of hysteroscopy and transvaginal sonography in diagnosis of endometrial pathology in abnormal uterine bleeding.Methods: A total 100 women attending gynaecological outpatient in hospital attached to J. J. M. Medical College, Davangere with abnormal uterine bleeding fitting into the inclusion criteria during November 2014 to August 2016, were admitted and evaluated with Transvaginal sonography (TVS) and hysteroscopy. Data was collected and analysed.Results: Among 100 patients of AUB in this study, majority of the patients were in perimenopausal age group. Menorrhagia is the most common presentation (45%) followed by postmenopausal bleeding (20%). Anaemia was detected in 79% of patients. Hysteroscopy was taken as gold standard and TVS findings were compared. The sensitivity of TVS in detecting polyps, submucous fibroid were 22.2%, 11% respectively and for the normal variants like proliferative and secretory it was 50% and 79.2% respectively. TVS showed good correlation with hysteroscope findings for normal variants of endometrium, but poor correlation for intracavitary pathologies.Conclusions: Hysteroscopy is a rapid, safe, well tolerated and highly accurate means of diagnosing the cause of abnormal uterine bleeding in perimenopausal age group. Thus, it is advised as a first line investigation in evaluation of AUB.

Etiological factors of abnormal uterine bleeding according to PALM- COEIN classification in perimenopausal women in a tertiary care centre

Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

Clinical pattern and presentation of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a very common debilitating gynecological condition among women of the reproductive age group. This diagnosis is given to women in whom no clear etiology is identified. It can occur in ovulatory and anovulatory cycle. It influences the physical, emotional, sexual and professional life of a woman. This study was carried out to evaluate the clinical profile of abnormal uterine bleeding.Methods: This cross-sectional study was carried out among 350 patients who were clinically diagnosed with AUB for a period of one year from April 2018 to March 2019. Patients with uterine polyp, adenomyosis, Leiomyoma, malignancies and with various coagulopathies were excluded from the study by physical examination, ultrasound, histopathology and blood test. The remaining 280 patients between the ages 20-60 years were selected for clinical classification of AUB.Results: Majority of the participants were in the age group of 41-50 years (60%). AUB is most commonly seen in multiparous women (48.92%). The prominent bleeding pattern seen was menorrhagia (52.2%).Conclusions: Menorrhagia is the most common form of AUB and there is a need to prevent the consequences of menorrhagia by way of creating awareness among the women, and by early diagnosis and clinical management of complications.

Study of etiopathogenesis and clinical profile of patients presenting with abnormal uterine bleeding

Background: AUB is a common condition affecting 14-25% of women of reproductive age and may have a significant impact on their physical, social, emotional and material quality of life. AUB can occur at any age in various forms and has different modes of presentation. The key to successful clinical management is to recognize or identify the causative factors responsible.Methods: This study was conducted over 100 patients. Patients with complaints of menstrual irregularity between menarche to premenopausal age group were considered. Data about age, parity, menstrual history, obstetric history, medical history, physical examination, thyroid function test, radiological findings and histopathology were collected and studied.Results: Incidence of AUB is more common in 5th decade of life. Menorrhagia is the most common bleeding pattern. It is concluded that DUB is the most common cause of AUB. Among the other organic pathological causes, fibroid is the commonest. Maximum number of apparently normal patients with abnormal uterine bleeding belong to category of sub clinical hypothyroid.Conclusions: Accurate analysis of endometrial sample is the key to effective therapy and rational approach to treatment of women with abnormal uterine bleeding.

A prospective study to compare levonogestrol intrauterine system and trans-cervical resection of endometrium for treatment of abnormal uterine bleeding

Background: This article is a study comparing the two most accepted forms of treatment for abnormal uterine bleeding - levonorgestrol intrauterine treatment and transcervical resection of endometrium, with regards to its acceptability, efficacy, adverse effects and user satisfaction. Aim of this study was to compare the acceptability, efficacy, adverse effects and user satisfaction of LNG-IUS and TCRE for treatment for AUB.Methods: A prospective observational study conducted in SKNMC and GH. Forty-nine women with abnormal uterine bleeding after hysteroscopic evaluation were included in this study; where 17 opted for LNG-IUS; 32 opted for TCRE with bipolar electrode. 15 patients in LNG-IUS group and 28 pts in TCRE group completed follow up. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, acceptability, satisfaction and reason for discontinuation were recorded at 6 weeks, 6 months and 12 months after the procedure. Prior to LNG-IUS insertion or endometrial ablation, endometrial and cervical pathology were excluded by D and C and cervical smear, respectively. TVUS was used to exclude possible causes of menorrhagia, including myomas and endometrial polyp as well as adnexal pathology. LNG-IUS insertion was performed as an office procedure one day after cessation of menstrual bleeding with a negative urine pregnancy test.Results: Menstrual blood loss reductions in TCRE and LNG-IUS groups were by 85.7% and 87.6% respectively after a year. Amenorrhoea was more common in TCRE group while spotting and systemic effects were more common in LNG-IUS group. Satisfaction and acceptance rates are higher in TCRE group.Conclusions: The TCRE and LNG-IUS are equally effective in reducing bleeding in AUB patients. Acceptance and satisfaction are better with TCRE, as a modality of treatment for AUB.

Prevalence of symptoms in hemophilia carriers in comparison with the general population: a systematic review

ABSTRACT Introduction: Hemophilia is well known in males, but poorly recognized in hemophilia carriers, who may have a hemorrhagic tendency, and the symptoms may be frequent and severe. Few studies have been done evidencing this bleeding in female carriers of the hemophilia gene. Objectives: To verify the prevalence of hemorrhagic symptoms in HC, compared to women in the general population. Material and method: The articles published between October 1996 and November 2016 were searched in the PubMed, Scielo, Lilacs, Web of Science, Scopus and Cochrane Central databases. Results and discussion: Seventy-five articles were found in electronic databases and 2 additional articles, through manual search in journal summaries and bibliographical references of other review articles. There is a limitation as to the number of studies that explore the association between the risk of hemorrhagic events and HC A or B. Among the few existing studies, there is a methodological difference, evidenced by control groups with distinct recruitments, divergent questionnaires and non-standardized concepts. Conclusion: This review verified the existence of a higher prevalence of hemorrhagic symptoms in the HC in some outcomes, however, due to the limitations of the few studies found, there is still insufficient evidence to state that the HC has a greater hemorrhagic tendency in relation to the general population.