DOI: https://doi.org/10.18370/2309-4117.2020.51.14-22

Chronic abnormal uterine bleedings and quality of women’s life. How to significantly improve the result?

Н. Ю. Педаченко, Т. М. Тутченко, Р. А. Тухтарян

Abstract


Purpose of the study: to determine the effect of iron and vitamin D subsidies on the quality of women’s life who receive pathogenetic therapy for abnormal uterine bleedings (AUB) caused by adenomyosis and/or endometrial polyps.

Materials and methods. 114 patients with chronic AUB were randomized into two groups. The main group consist of 58 women, including 46 women with chronic AUB and adenomyosis (AUB-A), 12 women with adenomyosis and endometrial polyps (AUB-A,P). Women with AUB-A were prescribed 2 mg dienogest daily for the treatment of adenomyosis, similarly to patients with AUB-A,P after hysteroresection. All women in the main group also took a vitamin complex (iron, folate, iodine, vitamin D3, docosahexaenoic acid). The control group included 56 patients (43 women with AUB-A, 13 women with AUB-A,P) who were prescribed etiopathogenetic treatment (dienogest 2 mg per day and/or hysteroresection for endometrial polyps) without a vitamin complex subsidy. Quality of life was assessed using the SF-36 questionnaire. All patients received serum concentrations of hemoglobin, ferritin and 25(OH)D before and 3 months after treatment.

Results. Iron-free dienogest therapy led to an increase serum hemoglobin levels after 3 months (p = 0.001). After three months vitamin complex Pregna-5 added there were significantly increased of hemoglobin levels, ferritin and 25(OH)D. This is accompanied by an improvement in the overall indicator of physical (r = 0.421, p <0.05) and psychological health (r = 0.385, p <0.05) on the SF-36 scale. An increase in serum ferritin greatly improves the psychological (r = 0.660, p <0.05) and physical components of women’s health (r = 0.522, p <0.05). Optimization of serum vitamin D levels improves physical health (r = 0.494, p <0.05). Conclusions. It is necessary to combine etiopathogenetic therapy with additional sources of vitamin D and iron for successful therapy of AUB and restoration of deficient conditions. This is significantly improves the quality of life.

Keywords


abnormal uterine bleedings; iron deficiency; vitamin D; anemia; quality of women’s life

References


Antypkin, Y.G., Kaminskyi, V.V., Tatarchuk, T.F. “Optimization of family planning service in ukraine in the realization of modern strategy of woman health maintenance.” Reproductive endocrinology 3.35 (2017): 7–10. DOI: 10.18370/2309-4117.2017.35.7-16

Bodnar, P.M., Mikhalchyshyn, G.P. “Iodine deficiency diseases and their prevention.” International Journal of Endocrinology 4.6 (2006).

Zaporozhan, V.M., Tatarchuk. T.F., Ber, A., et al. “National consensus of management patients with abnormal uterine bleeding by association of gynecologist and endocrinologist of Ukraine.” Reproductive endocrinology 1.21 (2015): 7–12. DOI: 10.18370/2309-4117.2015.21.7-14

Zaporozhan, V.M., Tatarchuk. T.F., Kaminskyi, V.V., et al. “National consensus on management patients with endometriosis.” Reproductive endocrinology 4.24 (2015): 7–12. DOI: 10.18370/2309-4117.2015.24.7-12

Ministry of Health of Ukraine. “Order No. 353 from April 13, 2016 «Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. Abnormal uterine bleeding.”

Povorozniuk, V.V., Balatska, N.I. “Deficiency of vitamin D among ukrainian population: risk-factors of development.” Reproductive endocrinology 5.13 (2013): 7–13. DOI: 10.18370/2309-4117.2013.13.7-13

Tatarchuk, T.F., Yefimenko, O.A., Shevchuk, T.V. “Current management of abnormal uterine bleeding.” Reproductive endocrinology 4.12 (2013): 18–27. DOI: 10.18370/2309-4117.2013.12.18-28

Antypkin, Y.G., Vdovychenko, Y.P., Graziottin, A., et al. “Uterine bleedings and quality of woman's life: Resolution of advisory board.” Reproductive Endocrinology 3.47 (2019): 13–18. DOI: 10.18370/2309-4117.2019.47.8-12

Rusińska, A., Płudowski, P., Zygmunt, A. “Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland – Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies – 2018 Update.” Front Endocrinol (Lausanne) 9 (2018): 246.

Bener, A., Kamal, M. “Higher Prevalence of Iron Deficiency as Strong Predictor of Attention Deficit Hyperactivity Disorder in Children.” Ann Med Health Sci Res 4.3 (2014): S291–S297.

Cooke, A.G., McCavit, T.L., Buchanan, G.R., Powers, J.M. “Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding.” J Pediatr Adolesc Gynecol 30.2 (2017): 247–50.

Wallace, D.F. “The Regulation of Iron Absorption and Homeostasis.” Biochem Rev 37.2 (2016): 51–62.

Edwards, M.H., Cole, Z.A., Harvey, N.C., Cooper, C. “The global epidemiology of vitamin D status.” The Journal of Aging Research & Lifestyle (2017)/ Available from: [ www.jarlife.net/703-the-global-epidemiology-of-vitamin-d-status.html].

Davis, E., Sparzak, P.B. “Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding).” StatPearls (2019). Available from: [http://www.ncbi.nlm.nih.gov/books/NBK532913/].

Graziottin, A. “The shorter, the better: A review of the evidence for a shorter contraceptive hormone-free interval.” Eur J Contracept Reprod Health Care 21.2 (2016): 93–105.

World Health Organization. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva. WHO (2012).

Intira Sriprasert, Tarita Pakrashi, David F. Archer. “Heavy menstrual bleeding diagnosis and medical management.” Contracept Reprod Med 2 (2017): 20.

The United Nations University. “Iodine deficiency in 2007: Global progress since 2003.” Food and Nutrition Bulletin 29.3 (2008).

World Health Organization. Iron deficiency anemia assessment, prevention and control. A guid for programme managers. Geneva. WHO (2001).

Lins, L., Carvalho, F.M. “SF-36 total score as a single measure of health-related quality of life: Scoping review.” SAGE Open Med 4 (2016): 2050312116671725

Whitaker, L., Critchley, H.O.D. “Abnormal uterine bleeding.” Best Practice & Research Clinical Obstetrics & Gynaecology 34 (2016): 54–65.

Holick, M.F., Binkley, N.C., Bischoff-Ferrari,H.A., et al. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96.7 (2011): 1911–30.

Munro, M.G., Critchley, H.O.D., Broder, M.S., Fraser, I.S. “FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.” Intern J Gynecol Obstet 1.13 (2011): 3–13.

Munro, M.G., Critchley, H.O.D., Fraser, I.S., FIGO Menstrual Disorders Committee. “The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.” International Journal of Gynecology & Obstetrics 143.3 (2018): 393–408.

National Collaborating Centre for Women’s and Children’s Health. Heavy menstrual bleeding clinical guideline (2007).

National Institute for Clinical Excellence. Guideline Development Methods: Information for National Collaborating Centres and Guideline Developers. London. NICE (2005).

Nishimura, M., Yaguti, H., Yoshitsugu, H. “Tissue distribution of mRNA expression of human cytochrome P–450 isoforms assessed by high-sensivity real-time reverse transcription PCR.” Yakugaku Zasshi 123.5 (2003): 369–75.

American College of Obstetricians and Gynecologists. “Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductiveaged women.” Obstet Gynecol 120 (2012): 197–206.

Scaglione, F., Panzavolta, G. “Folate, folic acid and 5-methyltetrahydrofolate are not the same thing.” Xenobiotica 44.5 (2014): 480–8.

Shelnutt, K.P., et al. “Methylenetetrahydrofolate reductase 677C–>T polymorphism affects DNA methylation in response to controlled folate intake in young women.” J Nutr Biochem 15.9 (2004): 554–60.

Tatarchuk, T.F., Kosei, N.V., Tutchenko, T.M. “Current diagnosis and treatment of abnormal uterine bleeding.” Reproductive Endocrinology 1 (2012): 74–8.

Vercellini, P., Vendola, N., Ragni, G., et al. “Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy.” Journal of Reproductive Medicine 38.7 (1993): 502–4.

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva. WHO (2016).

Yan Wang, Lan Huang. “Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.” PLoS One 12.1 (2017): e0169145.


GOST Style Citations


1.            Антипкін, Ю.Г. Оптимізація служби планування сім’ї в Україні в реалізації сучасної стратегії збереження здоров’я жінки / Ю.Г. Антипкін, В.В. Камінський, Т.Ф. Татарчук // Репродуктивна ендокринологія. – 2017. – № 3 (35). – С. 7–10.

2.            Боднар, П.М. Йододефіцитні захворювання та їх профілактика / П.М. Боднар, Г.П. Михальчишин // Міжнародний ендокринологічний журнал. – 2006. – № 4 (6).

3.            Запорожан, В.М. Національний консенсус щодо ведення пацієнток із аномальними матковими кровотечами Асоціації гінекологів-ендокринологів України / В.М. Запорожан, Т.Ф. Татарчук, А. Бер та ін. // Репродуктивна ендокринологія. – 2015. – №1 (21). – С. 7–12.

4.            Запорожан, В.М. Національний консенсус щодо ведення пацієнток із ендометріозом / В.М. Запорожан, Т.Ф. Татарчук, В.В. Камінський та ін. // Репродуктивна ендокринологія. – 2015. – № 4 (24). – С. 7–12.

5.            Міністерство охорони здоров'я України. Наказ № 353 від 13 квітня 2016  «Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги. Аномальні маткові кровотечі.

6.            Поворознюк, В.В. Дефіцит вітаміну D у населення України та чинники ризику його розвитку / В.В. Поворознюк, Н.І. Балацька // Репродуктивна ендокринологія. – 2013. – № 5 (13). – С. 7–13.

7.            Татарчук Т. Ф. Современный менеджмент аномальных маточных кровотечений / Т.Ф. Татарчук, О.А. Ефименко, Т.В. Шевчук // Репродуктивная эндокринология. – 2013. – № 4 (12). – С. 18–27.

8.            Антипкін, Ю.Г. Маткові кровотечі та якість життя жінки: резолюція Експертної ради / Ю.Г. Антипкін, Ю.П. Вдовиченко, А. Грациоттін та ін. // Репродуктивна ендокринологія. – 2019. – № 3 (47). – С. 13–18.

9. Rusińska, A., Płudowski, P., Zygmunt, A. “Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland – Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies – 2018 Update.” Front Endocrinol (Lausanne) 9 (2018): 246.

10.          Bener, A., Kamal, M. “Higher Prevalence of Iron Deficiency as Strong Predictor of Attention Deficit Hyperactivity Disorder in Children.” Ann Med Health Sci Res 4.3 (2014): S291–S297.

11.          Cooke, A.G., McCavit, T.L., Buchanan, G.R., Powers, J.M. “Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding.” J Pediatr Adolesc Gynecol 30.2 (2017): 247–50.

12.          Wallace, D.F. “The Regulation of Iron Absorption and Homeostasis.” Biochem Rev 37.2 (2016): 51–62.

13.          Edwards, M.H., Cole, Z.A., Harvey, N.C., Cooper, C. “The global epidemiology of vitamin D status.” The Journal of Aging Research & Lifestyle (2017)/ Available from: [ www.jarlife.net/703-the-global-epidemiology-of-vitamin-d-status.html].

14.          Davis, E., Sparzak, P.B. “Abnormal Uterine Bleeding (Dysfunctional Uterine Bleeding).” StatPearls (2019). Available from: [http://www.ncbi.nlm.nih.gov/books/NBK532913/].

15.          Graziottin, A. “The shorter, the better: A review of the evidence for a shorter contraceptive hormone-free interval.” Eur J Contracept Reprod Health Care 21.2 (2016): 93–105.

16.          World Health Organization. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva. WHO (2012).

17.          Intira Sriprasert, Tarita Pakrashi, David F. Archer. “Heavy menstrual bleeding diagnosis and medical management.” Contracept Reprod Med 2 (2017): 20.

18.          The United Nations University. “Iodine deficiency in 2007: Global progress since 2003.” Food and Nutrition Bulletin 29.3 (2008).

19.          World Health Organization. Iron deficiency anemia assessment, prevention and control. A guid for programme managers. Geneva. WHO (2001).

20. Lins, L., Carvalho, F.M. “SF-36 total score as a single measure of health-related quality of life: Scoping review.” SAGE Open Med 4 (2016): 2050312116671725

21.          Whitaker, L., Critchley, H.O.D. “Abnormal uterine bleeding.” Best Practice & Research Clinical Obstetrics & Gynaecology 34 (2016): 54–65.

22.          Holick, M.F., Binkley, N.C., Bischoff-Ferrari,H.A., et al. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96.7 (2011): 1911–30.

23.          Munro, M.G., Critchley, H.O.D., Broder, M.S., Fraser, I.S. “FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.” Intern J Gynecol Obstet 1.13 (2011): 3–13.

24.          Munro, M.G., Critchley, H.O.D., Fraser, I.S., FIGO Menstrual Disorders Committee. “The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.” International Journal of Gynecology & Obstetrics 143.3 (2018): 393–408.

25.          National Collaborating Centre for Women’s and Children’s Health. Heavy menstrual bleeding clinical guideline (2007).

26.          National Institute for Clinical Excellence. Guideline Development Methods: Information for National Collaborating Centres and Guideline Developers. London. NICE (2005).

27.          Nishimura, M., Yaguti, H., Yoshitsugu, H. “Tissue distribution of mRNA expression of human cytochrome P–450 isoforms assessed by high-sensivity real-time reverse transcription PCR.” Yakugaku Zasshi 123.5 (2003): 369–75.

28.          American College of Obstetricians and Gynecologists. “Practice Bulletin No. 128. Diagnosis of abnormal uterine bleeding in reproductiveaged women.” Obstet Gynecol 120 (2012): 197–206.

29.          Scaglione, F., Panzavolta, G. “Folate, folic acid and 5-methyltetrahydrofolate are not the same thing.” Xenobiotica 44.5 (2014): 480–8.

30.          Shelnutt, K.P., et al. “Methylenetetrahydrofolate reductase 677C–>T polymorphism affects DNA methylation in response to controlled folate intake in young women.” J Nutr Biochem 15.9 (2004): 554–60.

31.          Татарчук, Т.Ф. Діагностика і лікування аномальних маткових кровотеч / Т.Ф. Татарчук, Н.В. Косей, Т.М. Тутченко // Репродуктивна ендокринологія. – 2012. – № 1. – С. 74–78.

32.          Vercellini, P., Vendola, N., Ragni, G., et al. “Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy.” Journal of Reproductive Medicine 38.7 (1993): 502–4.

33.          World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva. WHO (2016).

34.          Yan Wang, Lan Huang. “Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.” PLoS One 12.1 (2017): e0169145.





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)