Page 39 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

high satisfaction rates. Nevertheless, this treatment is more invasive, it has to be performed by a gynaecologist, it is irreversible, it does not provide contraception and it has higher dysmenorrhea rates. Due to the lack of direct comparison of LNG-IUS with endometrial ablation, there is no evidence-based advice regarding the preference for one of these treatments. We propose a multicenter randomised controlled trial, organised in a network infrastructure in the Netherlands in which general practitioners and gynaecologists collaborate. Women ≥ 34 years of age with heavy menstrual bleeding, a Pictorial Blood Assessment Chart (PBAC) score exceeding 150 points and no desire for future children can participate in the trial. The primary outcome is the PBAC score at the 24-month follow-up. Secondary outcomes are patient satisfaction, complications, number of re-interventions, menstrual bleeding pattern, quality of life, sexual function, sick leave and costs. This study, which considers both the effectiveness and cost effectiveness of LNG- IUS versus endometrial ablation, may well improve care for women with heavy menstrual bleeding.
Besides effectiveness, women’s preferences are also very important in clinical decision-making. Understanding considerations in decision-making can contribute to further improvement in treatment counseling and can eventually lead to higher patient satisfaction rates. In Chapter 6 we perform a discrete choice experiment (DCE) to evaluate preferences between these two treatment options. We have selected the following characteristics: (1) procedure performed by gynaecologist or general practitioner (GP), (2) reversibility of procedure, (3) hormones, (4) dysmenorrhoea percentage, (5) use of contraception, (6) need to repeat the procedure after five years, (7) irregular bleeding percentage. Patient recruitment was performed in two Dutch hospitals and several general practices (GP) in the Netherlands. Women presenting with HMB were asked to participate. The main outcome measures were the relative importance of the characteristics and the willingness to make trade-offs between them.
One hundred and sixty-five women completed the questionnaire, 36 (22%) from GPs vs. 129 (78%) from gynaecologists. The most important characteristic was “Not requiring a treatment with hormones”. Women had a preference for least side- effects, and an irreversible method that did not require a repeat procedure, no use of additional contraception, and a procedure performed by a gynaecologist above a GP. A treatment without hormones would be traded for a treatment with hormones in exchange for an absolute 15% (95% CI 6.1 to 23.8) decrease in dysmenorrhea. Thus, although the majority of the participants preferred
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Summary
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