55 The ISTH-BAT score and outcomes after EA in women with HMB INTRODUCTION Bleeding disorders remain underdiagnosed in women with heavy menstrual bleeding (HMB) even though HMB is associated with a significant reduction in health-related quality of life (QoL). (1-3) The most common inherited bleeding disorder in women with HMB is the autosomal inherited Von Willebrand disease (VWD). Approximately 13% of women with HMB have underlying VWD. (2, 3) Vice versa, 81% of all women with VWD report HMB. (2, 3) Therefore, insight into the relationship between clinical bleeding pattern and effective treatment for HMB is of utmost importance. (2, 3) Standardized bleeding assessment tools, such as the International Society on Thrombosis and Haemostasis BAT (ISTH-BAT) (4), are useful screening tools to identify women with bleeding disorders during the diagnostic workup of heavy menstrual bleeding. These BAT tools can also be used to describe bleeding severity. (5) In addition to the ISTH-BAT, Halimeh et al. have postulated that a pictorial blood assessment chart (PBAC) score >100 is also a strong indicator of an underlying bleeding disorder when women experience HMB. (6) Furthermore, PBAC scores are investigated when being used in clinical practice as a measurement to assess the effectiveness of treatment options like bipolar radio-frequency impedance-controlled endometrial ablation (EA) in women with HMB. (7) Successful outcome of EA results in amenorrhea (absence of menstruation) in over 50% of the women with HMB, with a satisfaction rate between 80% to 96%. (8, 9) Re-intervention rates vary but are typically around 10%. (8, 9) Small retrospective studies and case reports showed highly successful results regarding EA in women diagnosed with VWD. (10-13) The aim of the current study was to investigate the association between the outcomes of EA in relationship to ISTH-BAT scores in women with HMB. This gives insight and could facilitate tailored gynecological counselling and treatment to women with HMB. METHODS This retrospective study was conducted at the Department of Gynecology, Gelre Hospitals Apeldoorn. The local institutional review board confirmed that the Medical Research involving Human Subjects act does not apply (Reference number: TCO 13.26). All patients referred for HMB and treated with EA between January 2010 and January 2014 were identified through the hospital’s patient administrative system (Dutch diagnosis-andtreatment code G11; menstrual cycle disorders) and invited to participate in our follow-up study at 2 till 5 years after initial EA. A formal sample size calculation was not performed, since the number of participants in this retrospective study was determined by the number of patients referred to our clinic. There were no exclusion criteria. Potential participants were informed about our study through an informed consent form. Participating was entirely voluntarily and 4
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