Objective: To evaluate different methods' efficacy of controlling acute
bleeding and managing long-term menstruation in patients with
heavy menstrual bleeding (HMB) associated with antithrombotic
therapy. Methods: The clinical data of 22 cases with HMB associated with antithrombotic
therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume,
hemoglobin (Hb), and quality of life were collected after control of acute
bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by
menorrhagia multi-attribute scale (MMAS). Results: (1) Treatment of acute
bleeding: of the 22 cases with HMB associated with antithrombotic
therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency
bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley
catheter balloon compression due to severe
bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic
therapy-related HMB, 15 (including 2 cases with severe
bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of
levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in
bleeding volume; 3 cases had controlled acute
bleeding after
rivaroxaban dose reduction and continued observation; 2 cases were given
gonadotropin-releasing hormone agonists to control acute
bleeding in other hospital, of which 1 case was temporarily treated with periodic
blood transfusion, and the other one patient underwent total
hysterectomy; and 2 cases had temporary
amenorrhea with oral
mifepristone after intrauterine balloon compression or oral
norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic
therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; Z=4.593, P<0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); Z=4.695, P<0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; Z=-3.062, P=0.002] before placement compared with 6 months after placement. Three
rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary
amenorrhea treated with oral
mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Conclusion: Intrauterine Foley
catheter balloon compression, aspiration or
endometrial ablation could be used to control acute
bleeding in patients with antithrombotic
therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase
hemoglobin, and improve the quality of life of patients.