2021 Update on abnormal uterine bleeding
Expert perspectives on a new cryotherapy device for endometrial ablation, the importance of quality of life issues in women with fibroids, and keeping up with randomized trials of elagolix with hormonal add-back therapy
QoL assessment in women with fibroids is useful in evaluating treatment success
Go VAA, Thomas MC, Singh B, et al. A systematic review of the psychosocial impact of fibroids before and after treatment. Am J Obstet Gynecol. 2020;223:674- 708.e8.
In many studies that assess AUB, the primary emphasis generally is placed on quantitation of menstrual bleeding by using PBLAC and alkaline hematin scores. In a systematic review, Go and colleagues argue the case for the importance of measuring the psychosocial impact of abnormal bleeding, emphasizing the concerning finding that many women with fibroids report lower vitality and lower social function scores than women with breast cancer.2
Fibroids associated with inconvenience—and anxiety
The authors analyzed and reviewed 18 randomized trials and 39 observational studies after screening 3,625 records from electronic database searches, with the goal to include only studies with validated quality of life (QoL) questionnaires that were administered both before and after treatment. A highlighted aspect of the reviewed studies was that “control” and “concern” subscales were most affected by fibroids, noting the inconvenience and anxiety that are related to the unpredictable onset and intensity of menses and the feeling of loss of control over one’s health and future.
This systematic review is important because although previous research has shown that fibroids significantly affect QoL, the psychosocial burden of fibroid symptoms had not been compared across different QoL instruments for both disease-specific and general validated health subscales.
Disability levels with fibroids are similar to those with other chronic diseases
Go and colleagues further reported that uterine fibroids have considerable psychosocial impact and lead to poor overall QoL physically and emotionally, with diminished sexual function and increased urinary or defecatory issues. Women with fibroids experienced a level of disability that was similar to that seen in other chronic diseases, and their vitality scores were lower than those associated with heart disease, diabetes, and as mentioned, breast cancer.
The authors concluded that “although objective clinical measures are important to establish a comprehensive understanding of health status, patient reported QoL outcomes play a critical role in evaluating success of a therapy.” They suggested that a larger emphasis on patient-centered care may help to mitigate the psychosocial effects of fibroids.
The study by Go and colleagues highlights the significant psychosocial aspects of the heavy menstrual bleeding associated with fibroids, and the authors found that many women with fibroids score in the range of those with other significant diseases, such as breast cancer and diabetes.
We have noted the trend of including QoL in research, and Go and colleagues make an excellent and compelling argument for this trend using quantitative analysis. It is important to consider this not only in our design of future research but also, and perhaps more importantly, in our clinical care of women as we try to better understand what they are experiencing.
Continue to: What have we learned over the past year about elagolix for uterine fibroids?...
