Skip to main content
Log in

Improving the Objective Quality of Large-Scale Clinical Trials for Women With Heavy Menstrual Bleeding: Experience from 2 Multi-Center, Randomized Trials

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

This study demonstrates a robust and thorough trial design leading to accurate and objective data collection. We recommend that future studies investigating heavy menstrual bleeding (HMB) should follow, and improve upon, this rigorous approach to menstrual trial data collection, not only to validate clinical results but also to improve the techniques used to acquire these results. We propose that the state-of-the-art methodology described here be used as the basis for new guidelines for the implementation of clinical trials in the area of HMB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Agency for Healthcare Research and Quality. Primary Care Management of Abnormal Uterine Bleeding (AUB). http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=850. Accessed September 18, 2012.

  2. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO Recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5): 383–390.

    Article  Google Scholar 

  3. National Institute for Health and Clinical Excellence. Collaborating Centre for Women’s and Children’s Health. Heavy menstrual bleeding. http://guidance.nice.org.uk/CG44/Guidance/pdf/English. Accessed September 18, 2012.

  4. Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007;22(3):635–643.

    Article  Google Scholar 

  5. Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007;87(3):466–476.

    Article  Google Scholar 

  6. Hallberg L, Hogdahl AM, Nilsson L, Rybo G. Menstrual blood loss–a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand. 1966;45(3): 320–351.

    Article  CAS  Google Scholar 

  7. Fraser IS, Langham S, Uhl-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol. 2009;4(2):179–189.

    Article  Google Scholar 

  8. Janssen CA, Scholten PC, Heintz AP. Reconsidering menorrhagia in gynecological practice. Is a 30-year-old definition still valid? Eur J Obstet Gynecol Reprod Biol. 1998;78(1):69–72.

    Article  CAS  Google Scholar 

  9. Kadir RA, Aledort LM. Obstetrical and gynaecological bleeding: a common presenting symptom. Clin Lab Haematol. 2000; 22(suppl 1):12–16; discussion 30–32.

    Article  Google Scholar 

  10. Hurskainen R, Grenman S, Komi I, et al. Diagnosis and treatment of menorrhagia. Acta Obstet Gynecol Scand. 2007;86(6):749–757.

    Article  CAS  Google Scholar 

  11. El-Hemaidi I, Gharaibeh A, Shehata H. Menorrhagia and bleeding disorders. Curr Opin Obstet Gynecol. 2007;19(6):513–520.

    Article  Google Scholar 

  12. James AH, Kouides PA, Abdul-Kadir R, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158(2): 124–134.

    Article  Google Scholar 

  13. King R, Overton C. Management of fibroids should be tailored to the patient. Practitioner. 2011;255(1738):19–23.

    PubMed  Google Scholar 

  14. Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2006;(2):CD003855.

  15. Beaumont H, Augood C, Duckitt K, Lethaby A. Danazol for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007; (3):CD001017.

  16. Lethaby A, Augood C, Duckitt K, Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;(4): CD000400.

  17. Lethaby A, Farquhar C, Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(4): CD000249.

  18. Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008;1: CD001016.

    Google Scholar 

  19. Lethaby A, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005;4: CD002126.

    Google Scholar 

  20. Fraser IS, McCarron G. Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Aust N Z J Obstet Gynaecol. 1991;31(1):66–70.

    Article  CAS  Google Scholar 

  21. Farquhar C, Brown J. Oral contraceptive pill for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009: CD000154.

  22. Shabaan MM, Zakherah MS, El-Nashar SA, Sayed GH. Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial. Contraception. 2010;83(1):48–54.

    Article  Google Scholar 

  23. Efficacy and safety study for the treatment of dysfunctional uterine bleeding. http://clinicaltrials.gov/ct2/show/NCT00293059?term=NCT00293059&rank=1. Accessed September 19, 2012.

  24. Efficacy and safety study for the treatment of dysfunctional uterine bleeding. http://clinicaltrials.gov/ct2/show/NCT00307801?term=NCT00307801&rank=1. Accessed September 19, 2012.

  25. Fraser I, Parke S, Mellinger U, Machlitt A, Serrani M, Jensen J. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011;16(4):258–269.

    Article  CAS  Google Scholar 

  26. Jensen JP, Mellinger U, Machlitt A, Fraser IS. Estradiol valerate/ dienogest OC for heavy and/or prolonged menstrual bleeding: a pooled analysis. Poster presented at: 58th American College of Obstetricians and Gynecologists Annual Clinical Meeting; April 2010; San Francisco, CA.

  27. Fraser IS, Warner P, Marantos PA. Estimating menstrual blood loss in women with normal and excessive menstrual fluid volume. Obstet Gynecol. 2001;98(5 Pt 1):806–814.

    CAS  PubMed  Google Scholar 

  28. Rees MC, Cederholm-Williams SA, Turnbull AC. Coagulation factors and fibrinolytic proteins in menstrual fluid collected from normal and menorrhagic women. Br J Obstet Gynaecol. 1985; 92(11):1164–1168.

    Article  CAS  Google Scholar 

  29. Baldwin RM, Whalley PJ, Pritchard JA. Measurements of menstrual blood loss. Am J Obstet Gynecol. 1961;81:739–742.

    Article  CAS  Google Scholar 

  30. Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990; 97(8):734–739.

    Article  CAS  Google Scholar 

  31. van Eijkeren MA, Scholten PC, Christiaens GC, Alsbach GP, Haspels AA. The alkaline hematin method for measuring menstrual blood loss–a modification and its clinical use in menorrhagia. Eur J Obstet Gynecol Reprod Biol. 1986;22(5–6): 345–351.

    Article  Google Scholar 

  32. Hallberg L, Nilsson L. Determination of menstrual blood loss. Scand J Clin Lab Invest. 1964;16:244–248.

    Article  CAS  Google Scholar 

  33. Shaw ST, Aaronson DE, Moyer DL. Quantitation of menstrual blood loss - further evaluation of the alkaline hematin method. Contraception. 1972;5(6):497–513.

    Article  Google Scholar 

  34. Moharram NM, El Aouad R, Al Busaidy S, et al. International collaborative assessment study of the AHD575 method for the measurement of blood haemoglobin. East Mediterr Health J. 2006;12(6):722–734.

    CAS  PubMed  Google Scholar 

  35. Heuck CC, Reinauer H, Wood WG. The alkaline haematin detergent (AHD575) method for the determination of haemoglobin in blood–a candidate reference measurement procedure. Clin Lab. 2008;54(7–8):255–272.

  36. Jensen J, Parke S, Mellinger U, Machlitt A, Fraser I. Effective treatment of heavy menstrual bleeding with estradiol valerate. Obstet Gynecol. 2011;117(4):777–787.

    Article  CAS  Google Scholar 

  37. Fraser IS, Römer T, Parke S. Effective treatment of heavy and/or prolonged menstrual bleeding with an oral contraceptive containing oestradiol valerate and dienogest: a randomised, double-blind Phase III trial. Hum Reprod. 2011;26(10):2698–2708.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ian S. Fraser DSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fraser, I.S., Zeun, S., Parke, S. et al. Improving the Objective Quality of Large-Scale Clinical Trials for Women With Heavy Menstrual Bleeding: Experience from 2 Multi-Center, Randomized Trials. Reprod. Sci. 20, 745–754 (2013). https://doi.org/10.1177/1933719113477492

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719113477492

Keywords

Navigation