Hemoglobin levels predict quality of life in women with heavy menstrual bleeding.

OBJECTIVE: This study was designed to evaluate the effects of heavy menstrual bleeding (HMB) on the quality of life (QoL). METHODS: A prospective, observational study was conducted including 58 patients with HMB, aged 35 years or older, with a negative pregnancy test result, menstrual blood loss >80 ml, uterine volume up to 200 cc and negative endometrial biopsy. The QoL was evaluated by interview using the Short Form-36 (SF-36) questionnaire. Blood loss, measured by Pictorial Blood Loss Assessment Chart (PBAC), and hemoglobin levels were also assessed. Statistical analysis was performed using the Pearson coefficient correlation test. RESULTS: The age of the patients ranged from 35 to 52 years (42.8+/-0.2 years). Increase in monthly expenses, negative implications in conjugal life, work impairment and health-care utilization due to HMB were seen in 96.5, 94.7, 66.7 and 59.6% of the patients, respectively. Hemoglobin levels correlated to SF-36 physical and mental composites scores (p=0.020 and p=0.027, respectively). PBAC score was not correlated with the QoL (physical composite score: p=0.222 and mental composite score: p=0.642) or with hemoglobin levels (r=-0.065; p=0.278). Hemoglobin and QoL showed significant improvement after treatment (p<0.001). Hemoglobin level was the only independent predictor of the QoL measured by SF-36 physical (p=0.03) and mental (p=0.04) composites scores. CONCLUSIONS: HMB had significant repercussions in the social, medical and economic aspects of women. The impact on the QoL was associated with the hematimetric parameters.

[Clinical usefulness of inhibin assays in gynecology and obstetrics]. / Aplicações das dosagens de inibinas em Ginecologia e Obstetrícia.

The main source of inhibin B in women is the growing follicle granulosa cells, while inhibin A is mainly produced by the corpus luteum and the placenta. In infertile women submitted to therapies of assisted reproduction, inhibin B has shown to be useful to predict a poor ovulatory response, though it has not yet overcome the performance of other markers. In the pre-natal screening of the Down syndrome, inhibin A has been repeatedly confirmed as useful in the second trimester and has also started to be considered in the first trimester test battery. Besides the two applications above, the dosage of total inhibin may contribute to the identification of cases of autoimmune ovarian insufficiency. Total inhibin may also be an auxiliary marker in the diagnosis of ovarian epithelial tumors, while the amount of inhibin B helps in the diagnosis of granulosa cells tumors. The use of inhibin A may be extended to the evaluation of pregnant women with risk of abortion, with a history of repeated abortion, with increased risk of pre-eclampsia, or even in the first days of follow-up of hydatiform mole post-emptying. All those applications are still under study, but with a real possibility of helping to extend the diagnostic spectrum of inhibin dosage in gynecology and obstetrics.