60 Chapter 4 continuous menstrual bleeding, were performed. The other 3 hysterectomies were performed because of vaginal prolapse. The PA reports described in four uteri leiomyomas, in six uteri adenomyosis, and two ordinary uteri. Overall, no major bleeding complications were described during initial EA or re-intervention (re-ablation, hysterectomy) in the ISTH-BAT ≥6 group nor in the ISTH-BAT <6 group. Table 2: The 36-item short-form health survey (SF-36) domain scores in patients with and without possible bleeding disorder, 2-5 years after EA. SF-36 Domain, median (IQR) ISTH-BAT <6 (n=55) ISTH-BAT ≥6 (n=16) η2 P-value † General health 75 (35) 72.5 (39) 0.014 0.310 Social functioning 87.5 (38) 75 (25) 0.001 0.757 Role-physical 100 (25) 100 (19) 0.002 0.620 Role-emotional 100 (0) 100 (0) 0.008 0.242 Mental health 80 (20) 80 (16) 0.003 0.688 Vitality 70 (25) 67.5 (39) 0.001 0.928 Physical functioning 95 (15) 95 (39) 0.008 0.442 (Bodily) pain 80 (33) 58.7 (39) 0.036 0.104 IQR, interquartile range; SF, short form. ISTH-BAT: International Society on Thrombosis and Haemostasis Bleeding Assessment. † Mann–Whitney U-test ISTH BAT <6 versus ISTH-BAT ≥6. η2 (eta squared) = 0.01 indicates a small effect size, η2 = 0.06 a medium effect size, and η2 = 0.14 a large effect size.[33] DISCUSSION In this retrospective cohort study in HMB patients treated with EA, we observed a relatively high coexistence of dysmenorrhea after EA (38% (6/16)) in ISTH-BAT ≥6 group compared to 18% (10/55) in the ISTH-BAT <6 group. Also, we observed that amenorrhea rate was lower in women with an increased ISTH-BAT score. However, EA remains an effective method to reduce HMB in women with both low and high ISTH-BAT scores. Furthermore, we observed that 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 versus 46.3, respectively) which may reflect the bleeding severity in this group and reveal HMB procedures at younger age. (5) The percentage of elevated ISTH-BAT scores in women with HMB in our study is in accordance with previous studies on (minor) bleeding disorders like VWD and/or coagulopathy in women with HMB. (2), (3), (24-27) Our cohort study reflects daily practice in which a practitioner is confronted with women referred because of HMB. The existing literature and expert committees recommend to screen on coagulation disorders in women suffering from HMB in gynecological practice before surgical treatment. (17), (28) Our findings emphasize that gynecologists should be aware of impaired coagulation, which might influence the outcome of endometrium ablation. (29, 30)
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