Page 36 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

Chapter 9
Heavy menstrual bleeding (HMB) is a common reason for general practice consultations in the primary care setting and specialist referral. About 30-50% of all menstruating women report their periods as (very) heavy, and of these women 25% report that their periods are a marked or severe problem. HMB has a significant impact on the medical, socio-economic and psychological well-being of women. Therefore, there is a need for effective diagnostic strategies and treatment modalities. This thesis deals with the (long-term) effectiveness of endometrial ablation and patient preference for second-generation ablation techniques versus LNG-IUS. Moreover, this thesis also provides insight into the outcome measures used in previous HMB research and investigates the value of the PBAC score as an outcome.
Chapter 1 outlines the aim of this thesis which is formulated in five questions:
1. What is the effectiveness of second-generation ablation techniques
at long-term follow-up?
2. Do patients prefer LNG-IUS or endometrial ablation in the treatment
of heavy menstrual bleeding?
3. What is the effectiveness of LNG-IUS compared to endometrial
ablation in the treatment of heavy menstrual bleeding?
4. Is there a relation between the Pictorial Blood Assessment Chart
score and treatment outcome?
5. What outcome measures are used in heavy menstrual bleeding
studies?
Prior to the discussion of the above questions, Chapter 2 gives an overview of the diagnosis of HMB. The clinician must take into account the fact that there is a wide variation in menstrual cycles and amount of blood loss between women. This variation should be discussed with the patient as this information can sometimes be reassuring for her. Besides, objectively knowing whether or not the blood loss is excessive could be very beneficial for both patient and clinician. This determination will clarify the patient’s complaint, and it will also influence the choice and expectations of treatment. The Pictorial Blood Assessment Chart (PBAC) score can help with diagnosis as it predicts HMB reliably. Nevertheless, besides the physical examination, we should also focus on women’s perception of blood loss. Many women who seek treatment for HMB complain about their physical, social and emotional well-being. For each woman a thorough history should be taken to establish the true nature of her
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