Abnormal uterine bleeding successfully treated via ultrasoundguided microwave ablation of uterine myoma lesions: Three case reports

BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.

Comparison on serum biomarkers for anovulatory and ovulatory dysfunctional uterine bleeding in Lizu females

Objective:To screen,identify,and compare the serum biomarkers between anovulatory dysfunctional uterine bleeding(ADUB)and ovulatory dysfunctional uterine bleeding(ODUB)in Lizu females.Methods:The subjects included 128 ADLB patients,63 ODUB patients,and 93controls.The serum and supernate of the subjects'mense were collected and stored at-80°C until use.Differential proteins in the sera of three groups were screened using surface-enhaneed laser desorption ionization time-of-flight mass spectrometry.The screened proteins were then identified by tricine-SDS-PAGE gel and spectrometry.Protein expression levels in the menses of ADUB,ODUB,and control subjects were determined using ELISA,RT-PCR,and Western blotting.SPSS 14.1 was used for statistical analysis and chart drawing(a=0.05),Results:Three differentia)protein peaks with peak values of 11.80,13.59,and 14.68 km/z were,screened and identified as serum amyploid protein A(SAA),vascular endothelial growth factor,and vitamin K epoxide reductase,respectively.The SAA was highly expressed in the menses of ADUB and ODUB patients but poorly expressed in the controls.The vascular endothelial growth factor was highly expressed in the menses of ODUB and controls but poorly expressed in ADUB patients.Meanwhile,the vitamin K epoxide reductase was highly expressed in the menses of ADUB and control subjects but poorly expressed in ODUB patients.Conclusions:The SAA is the common serum biomarker of ADUB and ODUB.ADUB may be related to angiogenesis impairment,whereas ODUB may be associated with blood coagulation disruption.

The Mechanisms of Abnormal Bleeding in Patients with Anovulatory Dysfunctional Uterine Bleeding

Objective To investigate the mechanisms of abnormal bleeding in patients with anovulatory dysfunctional uterine bleeding (DUB) and to analyze the correlation between vascular endothelial growth factor (VEGF) and microvessel density in the endometrium Materials & Methods Immunohistochemistry was used to study the expression of VEGF protein in the proliferative and hyperplastic endometrium. CD34 ,a marker of microvessel, was selected to measure microvessel density (MVD) in the endometrium.Fifteen women who were found to have no condition with normal menstrual cycles were set as control group.Results VEGF immunoreactivity in glandular epithelia cells was significantly lower in the hyperplastic endometrium than that of controls(P ＜ 0. 05). There was no significant difference in VEGF protein level between proliferative DUB endometrium and that of controls. A positive correlation was found between glandular VEGF and MVD in the endometrium(r=0. 666, P＜0.05). Conclusion The anovulatory DUB is associated with down-regulation of VEGF in the endometrium, and decreased secretion of VEGF will result in the disruption of angiogenesis, as a clinical manifestation of irregular bleeding.

Adolescence dysfunctional uterine bleeding:perspectives from the combination of traditional Chinese medicine and modern medicine

Because their endocrine system is not yet developmentally mature,adolescent girls are prone to dysfunctional uterine bleeding caused by insufficiency of the hypothalamic-pituitary-gonadal axis.The view of modern medicine is mainly aimed at the secretory function of sex hormones,such as estrogen and progesterone.However,it causes distress to patients because of the susceptibility of their treatment to endocrine system disorders.Traditional Chinese medicine considers the damage to the function of the Conception Vessel and Thoroughfare Vessel as the key to the disease.In this way,we guide the use of traditional Chinese medicine and acupuncture and achieve good results.The pathogenesis and management of functional uterine bleeding in adolescence are discussed from two medical perspectives in this article.

OBSERVATION ON THE THERAPEUTIC EFFECT OF COMBINED AURICULAR-PLASTER AND MOXIBUSTION THERAPIES FOR TREATMENT OF 500 CASES OF DYSFUNCTIONAL UTERINE BLEEDING

The present study reports results of 500 cases of dysfunctional uterine bleeding treatedwith combined auricular-plaster and moxibustion therapies. After treatment, 480 cases were cured,constituting 96. 0 %; 16 cases were improved, constituting 3. 2% and 4 had no any effect, constituting 0. 8 %. The total effective rate was 99. 2 %.

50 CASES OF DYSFUNCTIONAL UTERINE BLEEDING TREATED BY PUNCTURING THE EFFECTIVE POINTS -A New System of Acupuncture

All abnormal uterine bleeding as a re-sult of ovarian dysfunction is calleddysfunctional uterine bleeding which can beclassified from a physiopathological viewpoint into two types:ovulatory andanovulatory, belonging to the category inTCM of Beng Lou (burst out and drip, i.e.metrorrhagia and metrostaxis) or irregularmenstruation. For many years, the authorshave treated the disease by needling the ef-fective points with very satisfactory results.

The therapeutic efficacy and safety of Gongxuening capsule in dysfunctional uterine bleeding:a systematic review and meta-analysis

Background:Gongxuening capsule is a Chinese patent medicine for treating the dysfunctional uterine bleeding.We report a meta-analysis of the combination efficacy between conventional medicines with Chinese patent drug Gongxuening in the treatment of dysfunctional uterine bleeding.Materials and methods:Seven databases were used to retrieve the relevant research of Chinese patent drug Gongxuening treatment for dysfunctional uterine bleeding from the databases establishment to 2020.The data were extracted independently by 2 researchers according to the described selection research.The meta-analysis was performed using RevMan5.3 software.Results:This study included 23 randomized trials,with a total of 1,836 dysfunctional uterine bleeding patients.Chinese patent drug Gongxuening could significantly improve the effective rate,and reduce endometrial thickness,control bleeding time,complete hemostasis time and sex hormone level,and no serious adverse events.Based on sensitivity analysis and subgroup analysis,the heterogeneity sources of endometrial thickness,complete hemostasis time and sex hormone level were found.In follicle stimulating hormone and luteinizing hormone,there was no significant difference between the two groups when Chinese patent drug Gongxuening combined with desogestrel ethinylestradiol.Conclusion:Conventional medicines combined with Chinese patent drug Gongxuening can make patients with dysfunctional uterine bleeding achieve better effective rate,and no serious adverse events occurred.

A retrospective study on estrogen or contraceptives in the treatment of dysfunctional uterine bleeding in adolescent patients

Objective: To investigate the clinical efficacy of estrogen or contraceptives in the treatment of acute bleeding of dysfunctional uterine bleeding (DUB) in adolescent patients and the optimal starting dosage of drugs.Methods: The clinical records of 106 girls who with DUB and moderate or severe anemia from February 1990 to July 2005 were analyzed retrospectively.Results: All 106 patients received hormonal therapy. 56 patients were treated with estradiol benzoate(E2), 30 patients with conjugated equine estrogen(CEE) and 20 patients with combined oral contraceptives (COCs). The rates for rapidly controlling bleeding and for rapidly stopping bleeding in E2 group were higher than those in CEE group ,but similar to those in COCs group. The days for controlling and completely stopping bleeding were not significantly different between the starting dosages (≤8 mg/d and >8 mg/d) of E2 groups, and also there were no statistical difference between the starting dosages (<7.5 mg/d and ≥7.5 mg/d) of CEE groups, but during the treatment the rate of increasing the dosage in <7.5 mg/d group was higher than that of ≥7.5 mg/d group(40% vs. 5%),while there were no statistical difference between the starting dosages (≤3 pills/d and >3 pills/d) of COCs groups. Conclusions: The clinical efficiency of E2 treatment on DUB in adolescent patients is similar to that of COCs. And the efficacies of treatment of DUB with E2, CEE and COCs in the different dosages are similar.

Abnormal Uterine Bleeding due to Retention of Fetal Bones after Abortion: A Case Report

Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.

Importance of timely diagnosis and intervention in uterine artery pseudoaneurysm caused by hysteroscopic surgery

This manuscript explores the case on the occurrence of uterine artery pseudoaneurysm(UAP)during hysteroscopy endometrial polypectomy and the subsequent successful treatment via uterine artery embolization(UAE).Moreover,we focus on the management and treatment options for UAP in patients of advanced maternal age.A pseudoaneurysm is an extraluminal blood collection with a disrupted flow that communicates with the parent vessel via a defect in the arterial wall.The reported case involved a 48-year-old primiparous woman who developed a UAP after uterine polyp removal.The study enhances the understanding of UAP,a rare but potentially life-threatening condition,by providing a detailed and well-documented account of the comprehensive case presentation,effective use of medical imaging techniques for diagnosis,successful postoperative patient management following UAE,and practical clinical recommendations for clinicians managing similar cases.Overall,this study highlights the importance of considering UAP as a differential diagnosis in patients with abnormal vaginal bleeding following hysteroscopic surgery.Additionally,this manuscript recommends that clinicians with a high index of suspicion for UAP promptly request ultrasonography and computed tomography to facilitate early diagnosis.UAE is suggested as a primary treatment due to its effectiveness and safety,particularly in facilities capable of avoiding hysterectomy.

Clinical and Demographic Profile of Women with Uterine Fibroids Living in Puerto Rico

Introduction: Uterine leiomyomas, or fibroids, are prevalent benign tumors affecting up to 70% of reproductive-age women in the United States, significantly impacting productivity and quality of life. Despite their commonality, the epidemiology and clinical patterns of leiomyomas in Puerto Rico remain inadequately researched. Methods: This study conducted a secondary data analysis using clinical, menstrual cycle characteristics, and demographic data from self-administered questionnaires of women undergoing diagnostic laparoscopy for endometriosis in Puerto Rico. Chi-square tests and t-tests analyzed categorical and continuous variables, respectively (p Results: Among 1,610 endometriosis cases, 312 included uterine fibroids. Prevalence estimates were 10.3% (40 years). Primiparous women averaged 22.14 years, with 40.71% having 2 - 3 pregnancies and 26.28% experiencing miscarriages. Symptoms included infertility (29.5%), dyspareunia (40.7%), severe pain (50%), and dysmenorrhea (75.6%). Comorbidities included ovarian cysts (52.2%) and abnormal uterine bleeding (37.8%). Conclusions: Advanced age, parity, and comorbidities like diabetes and hypertension were prevalent in our cohort. Understanding the epidemiological profile of women living in Puerto Rico with uterine fibroids is crucial for improving diagnostic awareness and enhancing patient care.

Comparative Study between Endometrial Resection and Electrocoagulation in Patients with Abnormal Uterine Bleeding

Objective: To compare clinical outcomes between two first-generation endometrial ablation techniques. Design: Prospective comparative coorte. Setting: Tertiary public hospital, university teaching center. Seventy-three patients with abnormal uterine bleeding unresponsive to clinical treatment submitted to endometrial ablation from October 2011 to September 2013. Methods and Main Outcome Measures: Patients were assigned to either monopolar U-shaped electrode resection with rollerball electrocoagulation (group A, n = 36) or rollerball electrocoagulation alone (group B, n = 37). Mean follow-up length was 359 (280 - 751) and 370 days (305 - 766) in groups A and B, respectively. Bleeding pattern, associated symptoms, failure/success rates were assessed 30, 90, 180 and 360 days post-procedure. Findings: Patient characteristics were similar in both groups (P ≥ 0.05). Surgery duration (mean of 48.5 [±12.0] vs. 31.9 [±5.6] min, P Conclusions: Endometrial ablation using rollerball electrocoagulation alone may be considered safer than resection with rollerball electrocoagulation, which requires shorter surgical time and less distention medium, and is associated with lower postoperative vaginal discharge incidence. Success rate did not statistically differ between groups, but study parameters in absolute values and percents were superior in group B.

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Epidemiological Profile of Abnormal Uterine Bleeding at the Gyneco-Obstetric and Pediatric Hospital of Yaounde

Introduction:?Abnormal uterine bleeding (AUB) is one of the most commonly encountered symptoms in gynecological consultations. The prognosis is rarely endangered but the impact on the quality of life is sometimes important. Objective:?Our objective was to assess the epidemiological profiles of patients consulting for AUB at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital.?Methodology:?We carried out a descriptive cross-sectional study at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. We included all women with acute or chronic per vaginal bleeding and we excluded all cases of bleeding in pregnancy, bleeding due to infection, pre pubertal bleeding and the incomplete files. Data were?collected from January to May 2019, using a questionnaire, and analyzed using Epi Info version 3.5.4 and SPSS version 7. softwares. Results:?A total of 163 patient files were exploited and analyzed. The frequency of AUB in outpatient gynaecology clinics was 3.7%. AUB patients had a mean age of 36 ± 12.27 years and the most represented age group was 30 to 35 years, with 17.1% cases. Sixty-seven representing 41.1% patients were married, 23.9% were civil servants, 23.1% were tertiary employees, and 40.3% had secondary level of education. Almost 44.1% were nulliparous and 53.9% had unknown HIV status an 83.4% have never used contraception. Conclusion:?The frequency of AUB during gynecological consultations is 3.7%. Those women have an average age of 36 years, most of them are nulliparous and have never use contraception.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Research progress in the treatment of perimenopausal abnormal uterine bleeding with traditional Chinese and western medicine

In order to fully understand the research progress of Chinese and Western medicine in the treatment of perimenopausal abnormal uterine bleeding,this paper reviews all kinds of research by referring to related literature reports at home and abroad.The results showed that western medicine mainly used hormone drugs,supplemented by surgery,but the clinical adverse reactions were more and the recurrence rate was higher;traditional Chinese medicine often obtained satisfactory results through the treatment of traditional Chinese medicine,syndrome differentiation,stage treatment,acupuncture and other treatment methods,with fewer adverse reactions and low recurrence rate,but the effect of sudden collapse and hemostasis was slower;the combination of Chinese and Western medicine can learn from each other and become The research focus in recent years is worthy of further discussion.

The Prognostic Value of BMI, Serum Glucose, Endometrial Echo Pattern and Uterine Artery Doppler Velocimetry as a Predictor for Endometrial Pathology in Women with Postmenopausal Bleeding (Prospective Observational Study)

Background: Post-menopausal bleeding is a warning sign that accounts for about 5% of all outpatient gynaecologic visits and is a common indication for referral to rapid access clinics because of the fear of underlying malignancy. Endometrial malignancies differ from other malignancies in that early symptomization is common, allowing early cure. Patients and Methods: During the study period, 100 women with post-menopausal bleeding having inclusion criteria were evaluated in Al Hussein University Hospital. For each patient full history, general, abdominal and pelvic examination was performed. Routine pre-operative investigations were done. Patients were divided into four groups: Group 1 included 29 patients with endometrial polyp. Group 2 included 34 patients with endometrial hyperplasia. Group 3 included 21 patients with atrophic endometrium. Group 4 included 16 patients with endometrial carcinoma. Results: As regards the predictive value of BMI, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. When discussing the predictive value of blood glucose level, in the study there was a high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. It is worth to mention that the predictive value of endometrial thickness, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups providing the highest specificity and sensitivity. At the last the predictive value of uterine artery velocimetry, in the study, was with high statistical significance in comparison between the endometrial carcinoma group and all other benign groups. Conclusion: BMI, blood glucose level, endometrial thickness and uterine artery velocimetry indices, improve the prediction of endometrial carcinoma in women with post-menopausal bleeding.

Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

ve To investigate the relationship between estradiol, progesterone and endothe-lin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant

Study on mechanism of Radix Paeoniae Rubra-Cortex Moutan in treatment of abnormal uterine bleeding based on network pharmacology

Objective:To explore the mechanism of the treatment of abnormal uterine bleeding with Radix Paeoniae Rubra-Cortex Moutan.Methods:To search the effective elements and action targets of paeony peony skin drug pair by searching the pharmacology platform of traditional Chinese medicine system;to select the disease targets of abnormal uterine bleeding by searching the human gene information database;to select the common targets of drugs and diseases by R language,to construct the interaction network of drugs compounds action targets diseases by using the software of Cytoscape;to construct the protein-protein interaction network by using the string platform The interaction network(PPI)was used to visualize the results,and the bio information package of Bioconductor was used to analyze go function enrichment and KEGG pathway.Results:This study included 16 compounds and 67 key targets.After enrichment analysis,87 go functional items and 116 KEGG signaling pathways were obtained.Quercetin,scutellarin,kaempferol and stigmasterol in Radix Paeoniae Rubra-Cortex Moutan directly act on interleukin-6,epidermal growth factor receptor,cystatin 3,mitogen activated protein kinase 8,vascular endothelial growth factor and other related targets,and are mainly enriched in Kaposi sarcoma associated herpesvirus infection and hepatis B.Age-range,TNF and other signal pathways.Conclusion:Radix Paeoniae Rubra-Cortex Moutan may play the role of anti-cell proliferation and apoptosis,protection of vascular endothelium,anti-inflammatory response,regulation of hormone secretion,and improvement of antioxidant activity through multi-component and multi-target,and play the role of treatment of abnormal uterine bleeding.

Research Progress on Treatment of Abnormal Uterine Bleeding during Puberty with Traditional Chinese and Western Medicine

In recent years,the frequency of clinical occurrence of abnormal uterine bleeding in adolescence has gradually increased.In order to fully understand the research progress in the treatment of abnormal uterine bleeding in adolescence,various studies and clinical experience have been reviewed by consulting related literature reports.The results found that currently Western medicine mainly uses hormone drugs in clinical treatment,but there are risks such as more clinical adverse reactions and higher recurrence rate;traditional Chinese medicine(TCM)treatment has achieved satisfactory results,but the advantages of sudden collapse and hemostasis are not obvious.Combined TCM and Western medicine treatment,it can learn from each other and has become a research hotspot in recent years,which is worthy of an in-depth discussion.