Centre for Academic Primary Care, University of Nottingham, Nottingham.
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham.
Br J Gen Pract. 2022 Nov 24;72(725):e857-e864. doi: 10.3399/bjgp.2022.0260. Print 2022 Dec.
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.
To assess continuation rates of medical treatments and rates of surgery in women 10 years after initial management for HMB in primary care.
This was a prospective observational cohort study.
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.
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 = 34, 16.5%; endometrial ablation = 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.
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.
月经过多（HMB）是一种常见的问题，会严重影响女性的生活。关于治疗后长期结果的证据不足。
评估初级保健中 HMB 初始治疗 10 年后，女性继续接受药物治疗和手术治疗的比率。
这是一项前瞻性观察性队列研究。
参加 ECLIPSE 初级保健试验（ISRCTN86566246）的 HMB 女性在随机分配到左炔诺孕酮宫内节育系统（LNG-IUS）或其他常用药物治疗（口服氨甲环酸、甲芬那酸、雌孕激素联合治疗；或单独孕激素治疗）后 10 年完成问卷调查。使用 36 项简短健康调查问卷（SF-36）和欧洲五维健康量表（EQ-5D）评估手术、药物治疗和生活质量的比率。
206 名回复问卷的女性在人口统计学和临床方面与原始试验人群具有代表性。基线时的平均年龄为 41.9 岁（SD 4.9），随访时为 53.7 岁（SD 5.1）。在 10 年的随访期间，206 名女性中有 60 名（29.1%）接受了手术（子宫切除术 34 例，16.5%；子宫内膜消融术 26 例，12.6%）。在 5 到 10 年间，89 名女性（43.2%）停止了所有药物治疗，88 名女性（42.7%）单独或联合使用 LNG-IUS。56 名女性（27.2%）在 10 年后仍在使用 LNG-IUS。生活质量评分随时间有所提高，两组之间在这些或其他结果方面没有差异。
在初级保健中可以成功地为 HMB 女性启动药物治疗，手术率较低，10 年后生活质量得到改善。
