62 Chapter 4 Strengths and limitations The strengths of the present cohort are the use of validated questionnaires to evaluate menstrual score, bleeding assessment score and QoL scores in the follow-up after EA in women with HMB and ISTH BAT ≥6 versus ISTH BAT <6 group. The study is limited by its retrospective design, relatively low participation rate of 35% (88/253) hampering the interpretation of SF-36 scores and limiting the generalizability of this explorative study. The study’s small sample size, especially in the ISTH-BAT ≥6 group, could have restricted our ability to identify statistically significant differences between the groups. In the total group more women reported amenorrhea at 2-5 years after initial EA (76%) compared to the women treated with EA for HMB described in the literature (50%). (9) This can probably be explained by the mean age of 45.4 years in our study which is higher than described in the literature, which might overestimate amenorrhea, and underestimate dysmenorrhea and re-interventions as a result of reaching menopause at follow-up. Also, dysmenorrhea rates were not structurally determined prior to EA treatment as it was not standard practice in our outpatient clinic at the time of the study. As a result, the percentage of individuals who experienced dysmenorrhea prior to the procedure is unknown. CONCLUSION In conclusion, ISTH-BAT score ≥6 seems to be associated with a lower age for EA, with a lower amenorrhea rate and relatively high coexistence of dysmenorrhea after EA in healthy women with HMB. Further studies are required to address whether the ISTH-BAT with age-adjusted reference ranges as a variable should be included to discriminate between women with a high or a low risk of EA failure. As EA resulted in an effective reduction of HMB and high QoL scores, we think it can be safely advised in the treatment of women with high BATs. After all, the lower incidence of amenorrhea, and higher dysmenorrhea rate did not result in more surgical re-interventions. Therefore, prospective research in larger groups of patients is required to validate our findings and to investigate whether screening for (minor) bleeding disorders in healthy women with HMB before initiation of EA is both necessary and cost-effective to avoid re-interventions and to set realistic expectations for the outcome of EA and discuss the potential for continuous bleeding and painful menstrual periods after the procedure.
RkJQdWJsaXNoZXIy MTk4NDMw