What Are Menorrhagia Patients Looking For?

Patients with menorrhagia, also known as heavy menstrual bleeding (HMB), may feel overwhelmed by the number of treatment options available. The role of the healthcare professional is to help each patient choose the treatment that best fits their unique needs and goals. Before talking through each option, it’s essential to have a deep understanding of what patients are looking for in their treatment.

Why Patients with Heavy Menstrual Bleeding Seek Treatment 

HMB impacts nearly every aspect of a woman’s life. One survey found that patients with menorrhagia scored significantly low in all dimensions of the quality of life scale: physical and social function, general and mental health, energy, and pain.¹ For some, the inability to perform daily activities is more detrimental than excessive bleeding and cramping.¹ A recent study linked menstruation-related symptoms to 22% of work-related absences and an average productivity loss of 33% per day.² 

In addition to a reduced quality of life, HMB also puts patients at risk for iron-deficiency anemia. While initial symptoms, like fatigue and lightheadedness, may be more of an inconvenience, a severe deficiency can lead to potentially dangerous complications, such as tachycardia and heart failure.³ 

When patients suffering from HMB seek help from their gynecologist, they’re hoping to find an efficient treatment that will successfully reduce bleeding and cramping, effectively returning their periods to normal and improving quality of life.

Characterizing the Ideal Procedure

Identifying treatment begins with understanding patient goals and providing her with options. The first choice will likely be a more conservative medical therapy. However, if medical therapy is unsuccessful or not preferred, the following discussion should include an in-depth review of both short- and long-term outcomes and complications of each surgical option. 

Hysterectomy is often a last resort for patients, given the higher risk of complications, longer recovery times, and greater financial responsibility.⁴ If a patient’s desired treatment outcome is to no longer have periods, then hysterectomy is the only procedure guaranteed to induce amenorrhea. According to the ACOG Practice Bulletin #81: 

“Patients who choose endometrial ablation should be willing to accept normalization of menstrual flow, not necessarily amenorrhea as an outcome.” ⁵

This puts the onus on gynecologists to recommend a less invasive procedure that achieves optimal outcomes — most importantly, a manageable period. A market research survey shows that 86% of women who suffer from HMB define treatment success as a normal period — or better.⁶ Additionally, 70% of patients would prefer treatment in an office setting.⁶ 

While the remaining surgical options can effectively treat many underlying uterine-related causes of HMB, physicians should select the procedure that will address patient goals and maximize patient satisfaction while ensuring the best clinical outcomes.

Why Endometrial Cryoablation May Be the Answer

Providing a less invasive yet clinically effective treatment for HMB, endometrial ablation is often the procedure of choice for many women looking to restore a normal period. The ablation treatment is well-understood to improve quality of life by alleviating the painful and often debilitating symptoms of menorrhagia, and they can be performed using both heat- and cold-based techniques. 

The Cerene® Cryotherapy Device uses nitrous oxide to freeze the endometrial lining. Cryotherapy not only destroys the endometrium, but also delivers a natural numbing effect, thereby minimizing the need for major pain management. Because the procedure can be performed without general anesthesia or IV sedation, physicians and patients can work together to choose the best site of service for each patient — either in the familiarity and comfort of the office or in the operating room or ASC.

When performed in the office, patients may be monitored for a short period and then return home, most resuming normal activities within 24 hours. Typically, patients see a significant improvement in their symptoms within 3 to 6 months. According to patient-reported data, 90% experienced light, normal, or no periods^†, and 86% saw a large reduction in dysmenorrhea.^‡ Overall, 90% of patients are satisfied with Cerene and report little to no limitations in their activities.^† Moreover, Cerene has been shown to result in minimal intrauterine adhesion growth which can help preserve cavity access , including 91% cavity visualization and the ability to evaluate 96% of those cavities for pathologic change — a critical aspect of the treatment paradigm.

Learn more at https://cerene.com/healthcare-professionals/. 

† Patient-reported data are 1 year after treatment with durable results at 3 years

‡ Improvement reported for patients reporting severe/very severe cramping

Key Takeaways: 

• Patients are looking for an HMB treatment that improves their quality of life with a manageable menstruation.
• If a surgical procedure is needed and a hysterectomy can be avoided, many patients wish to be treated in the familiarity and comfort of their doctor’s office.
• Cerene provides an efficient and well-tolerated treatment that significantly reduces bleeding and dysmenorrhea with little to no limitations on daily activities.

Important Safety Information

Cerene® Cryotherapy Device is indicated to ablate the endometrial lining of the uterus in premenopausal women with heavy menstrual bleeding due to benign causes for whom childbearing is complete. Pregnancy following the Cerene procedure can be dangerous; therefore, contraception must be used until menopause. The Cerene procedure is not for those who have or suspect uterine cancer; have an active genital, urinary or pelvic infection; or an IUD. There are risks and considerations associated with the use of the Cerene Cryotherapy Device. Temporary side effects may include uterine cramping, vaginal infection, and lightheadedness. For detailed benefit and risk information, consult the Cerene Instructions for Use (IFU) or your healthcare professional. Learn more >

Sources:

1. Gokyildiz, S., Aslan, E., Beji, N.K., & Mecdi, M. (2013). The Effects of Menorrhagia on Women’s Quality of Life: A Case-Control Study. ISRN Obstetrics and Gynecology 2013, 918179.
2. Schoep, M. E., Adang, E. M. M., Maas, J. W. M., De Bie, B., Aarts, J. W. M., & Nieboer, T. E. (2019). Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ open 9(6), e026186.
3. Iron deficiency anaemia. (n.d.). NHS inform. https://www.nhsinform.scot/illnesses-and-conditions/nutritional/iron-deficiency-anaemia  
4. Carugno, J. & Fatehi, M. (2023, January 4). Abdominal Hysterectomy. In StatPearls. StatPearls Publishing. Retrieved May 11, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK564366/ 
5. ACOG Committee on Practice Bulletins (2007). ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 81, May 2007. Obstetrics and gynecology, 109(5), 1233–1248.
6. Data on file. Channel Medsystems Market Research Iris Survey 2014.