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Medical treatment for heavy menstrual bleeding in primary care: 10-year data from the ECLIPSE trial
Joe Kai1, Brittany Dutton1, Yana Vinogradova1
1Centre for Academic Primary Care, University of Nottingham, Nottingham.
Insights
Long-term management of heavy menstrual bleeding (HMB) in primary care shows low surgery rates and improved quality of life. Most women either cease medical treatments or continue with the levonorgestrel-releasing intrauterine system (LNG-IUS) after a decade.
Area of Science:
- Reproductive Medicine
- Women's Health
- Primary Care Research
Background:
- Heavy menstrual bleeding (HMB) is a prevalent gynecological condition impacting women's quality of life.
- There is a significant gap in understanding the long-term outcomes of HMB management initiated in primary care settings.
Purpose of the Study:
- To evaluate the continuation rates of medical treatments for HMB.
- To determine the rates of surgical interventions for HMB.
- To assess long-term quality of life in women 10 years after initial HMB management.
Main Methods:
- A prospective observational cohort study design was employed.
- Women from the ECLIPSE primary care trial were followed up for 10 years post-randomization.
- Data on treatment continuation, surgical rates, and quality of life (SF-36, EQ-5D) were collected via questionnaires.
Main Results:
- A total of 206 women were included in the follow-up cohort.
- Over 10 years, 29.1% of women underwent surgery (hysterectomy or endometrial ablation).
- Quality of life scores improved significantly over the decade, with no significant differences between treatment groups.
Conclusions:
- Medical treatments for HMB are effective when initiated in primary care.
- Long-term follow-up indicates low rates of surgical intervention and sustained improvements in quality of life.
- The levonorgestrel-releasing intrauterine system (LNG-IUS) remains a viable long-term option for managing HMB.
Background:
Heavy menstrual bleeding (HMB) is a common problem that can significantly affect women's lives. There is a lack of evidence on long-term outcomes after seeking treatment.
Aim:
To assess continuation rates of medical treatments and rates of surgery in women 10 years after initial management for HMB in primary care.
Design And Setting:
This was a prospective observational cohort study.
Method:
Women with HMB who participated in the ECLIPSE primary care trial (ISRCTN86566246) completed questionnaires 10 years after randomisation to the levonorgestrel-releasing intrauterine system (LNG-IUS) or other usual medical treatments (oral tranexamic acid, mefenamic acid, combined oestrogen-progestogen; or progesterone alone). Outcomes were rates of surgery, medical treatments, and quality of life using the 36-item Short-Form Health Survey (SF-36) and EuroQoL EQ-5D.
Results:
The responding cohort of 206 women was demographically and clinically representative of the original trial population. Mean age at baseline was 41.9 years (SD 4.9) and 53.7 years (SD 5.1) at follow-up. Over the 10-year follow-up, 60 of 206 (29.1%) women had surgery (hysterectomy n = 34, 16.5%; endometrial ablation n = 26, 12.6%). Between 5 and 10 years, 89 women (43.2%) ceased all medical treatments and 88 (42.7%) used LNG-IUS alone or in combination with other treatments. Fifty-six women (27.2%) were using LNG-IUS at 10 years. There were improvements over time in quality-of-life scores, with no evidence of differences in these or other outcomes between the two groups.
Conclusion:
Medical treatments for women with HMB can be successfully initiated in primary care, with low rates of surgery and improvement in quality of life observed a decade later.
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