59 The ISTH-BAT score and outcomes after EA in women with HMB RESULTS We identified 253 patients referred to our hospital because of HMB and treated with EA between January 2010 and January 2014. Eighty-eight women (35%; 88 out of 253) consented to participate in this study. Seventeen of these 88 women were excluded from the study because they did not complete the questionnaires or missed the follow-up visit. The final study group consisted of 71 women (Figure 1). There were no differences between the women who participated in this study and those who declined participation (Supplement 1). The median ISTH-BAT score of the total study group was 4 (IQR: 1) and the mean age was 45.4 (SD 4.99) years. Twenty-three percent of women (n=16) had an ISTH-BAT ≥6 score, suggesting a possible bleeding disorder versus 77% (n=55) women with an ISTH-BAT score <6 (Table 1). Women with an ISTH-BAT score ≥6 had undergone EA at a significantly younger age than women with an ISTH-BAT score <6 (mean age 42.3 years (SD 4.3) vs. 46.3 (4.8), p=0.004). Effect of endometrial ablation (2 till 5 years follow-up) In our study group, 76% (55/71) of the women reported absence of menstruation after EA (Table 1). Fewer women in the ISTH-BAT ≥6 score group reported amenorrhea after EA (63% (10/16)) than women in the ISTH-BAT <6 group (82% (45/55)), (OR 0.76 (95% CI 0.32-1.85, p=0.550)) (Table 1). Dysmenorrhea after EA was mentioned by 38% (6/16) of the women in the ISTH-BAT ≥6 versus 18% (10/55) women in the ISTH-BAT <6 group (OR 2.70(95% CI 0.80-9.17, p=0.111)). In the ISTH-BAT score ≥6 group, all 6 women who did not have amenorrhea also reported dysmenorrhea. In the ISTH-BAT <6 group, of the 10 women who did not have amenorrhea, 9 reported dysmenorrhea, whereas one woman reported both amenorrhea and dysmenorrhea. Quality of life (2 till 5 years follow-up) (Bodily) pain was lower (η 2 = 0.036), in the ISTH-BAT ≥6 group versus the ISTH-BAT <6 group (median score 58.7 vs. 80, p=0.104) (Table 2). All other SF-36 domain scores were comparable between the ISTH-BAT ≥6 group versus the ISTH-BAT <6 group after EA. Surgical re-intervention and major intra-operative bleeding (10 years follow-up) Within 10 years of follow-up, 22% (17/71) of women had undergone a re-intervention after initial EA: 19% (3/16) in the ISTH-BAT ≥6 group versus 25% (14/55) in the ISTH-BAT <6 group (OR 0.68 95% CI 0.17-2.73, p=0.582) (Table 1). In the ISTH-BAT ≥6 group, 0 re-ablations and 3 hysterectomies (19%; 3/16) were performed because of continuous menstrual bleeding after EA. The pathology (PA) reports mentioned one uterus with myoma, one with adenomyosis, and one uterus without additional pathology. In the ISTH-BAT <6 group, 2 re-ablations (rollerball) (3%; 2/55), and 12 hysterectomies (22%; 12/55), of which 9 hysterectomies because of 4
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