Publications (23)99.16 Total impact
-
Article: Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety.
[show abstract] [hide abstract]
ABSTRACT: Tranexamic acid has proven to be an effective treatment for heavy menstrual bleeding (HMB). It reduces menstrual blood loss (MBL) by 26%-60% and is significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate, while the levonorgestrel-releasing intrauterine system reduces MBL more than tranexamic acid. Other treatments used for HMB are oral contraceptives, danazol, and surgical interventions (endometrial ablation and hysterectomy). Medical therapy is usually considered a first-line treatment for idiopathic HMB. Tranexamic acid significantly improves the quality of life of women treated for HMB. The recommended oral dosage is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle. Adverse effects are few and mainly mild. No evidence exists of an increase in the incidence of thrombotic events associated with its use. An active thromboembolic disease is a contraindication. In the US, a history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis or thromboembolism are considered contraindications as well. This review focuses on the efficacy and safety of tranexamic acid in the treatment of idiopathic HMB. We searched for medical literature published in English on tranexamic acid from Ovid Medline, PubMed, and Cinahl. Additional references were identified from the reference lists of articles. Ovid Medline, PubMed, and Cinahl search terms were "tranexamic acid" and "menorrhagia" or "heavy menstrual bleeding." Searches were last updated on March 25, 2012. Studies with women receiving tranexamic acid for HMB were included; randomized controlled studies with a description of appropriate statistical methodology were preferred. Relevant data on the physiology of menstruation and the pharmacodynamics and pharmacokinetics of tranexamic acid are also included.International Journal of Women's Health 01/2012; 4:413-21. -
Article: The effect of hysterectomy or levonorgestrel-releasing intrauterine system on premenstrual symptoms in women treated for menorrhagia: secondary analysis of a randomized controlled trial.
[show abstract] [hide abstract]
ABSTRACT: To study the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on premenstrual symptoms in women treated for menorrhagia. Secondary analysis of a randomized controlled trial. Five university hospitals in Finland. A cohort of 236 women, aged 35-49 years (mean 43 years) referred for menorrhagia between 1994 and 1997. Women were not diagnosed with premenstrual syndrome. Women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Analyses were performed using the intention-to-treat and actual treatment principles. Women using estrogen therapy and women who underwent bilateral salpingo-oophorectomy were excluded from the analyses. The occurrence of premenstrual symptoms evaluated by questionnaires at baseline and at follow-up visits six and 12 months after the treatment and five years after the randomization. Premenstrual symptoms decreased significantly in both groups by six months (p≤0.028) without significant differences between the groups, except that in the LNG-IUS group the decrease of breast tenderness was seen first by 12 months (p=0.048). Even though 42% of the women assigned to treatment with LNG-IUS were hysterectomized during the follow-up period, the results of intention-to-treat and actual treatment analyses were comparable. Both hysterectomy and LNG-IUS seem to alleviate premenstrual symptoms of women treated for menorrhagia, while the effect of these treatments on premenstrual syndrome remains unsettled.Acta Obstetricia Et Gynecologica Scandinavica 12/2011; 91(3):318-25. · 1.77 Impact Factor -
Article: Cost-effectiveness and quality of life associated with heavy menstrual bleeding among women using the levonorgestrel-releasing intrauterine system.
[show abstract] [hide abstract]
ABSTRACT: To review the literature for economic and health-related quality of life outcomes data associated with the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the management of heavy menstrual bleeding. We searched the MEDLINE and EMBASE databases simultaneously using the Ovid interface to review the literature in a systematic manner for economic and health-related quality of life outcomes data associated with the use of the LNG-IUS in women with heavy menstrual bleeding. Articles were then selected for further review based on the relevance of their titles and/or abstracts. We identified 17 articles for inclusion in this review. Treating heavy menstrual bleeding with the LNG-IUS was found to be cost-effective in various countries and settings. Moreover, irrespective of the measuring instrument used, health-related quality-of-life outcomes were found to be improved to a degree similar to that achieved with endometrial ablation or hysterectomy. In some cases, the LNG-IUS appeared to be more effective and less costly than the surgical options. The LNG-IUS is a cost-effective treatment option for heavy menstrual bleeding when pharmacologic treatment is indicated.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2011; 112(3):171-8. · 1.41 Impact Factor -
Article: Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine system.
[show abstract] [hide abstract]
ABSTRACT: Misoprostol has been studied intensively to produce cervical dilatation. To date, no studies have evaluated the effectiveness, safety or acceptability of this treatment for repeat intrauterine device insertions. This study was a randomized, double-blind, placebo-controlled trial on the consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS). Women who had used their first LNG-IUS for 4 years and 3 to 9 months and opted for an immediate replacement with a second LNG-IUS received a single sublingual dose of 400 mcg misoprostol or placebo 3 h prior to the LNG-IUS insertion. The proportion of easy insertions as judged by the investigator was 93% (40/43) in subjects randomized to misoprostol and 91% (42/46) in the placebo group (p=1.0 for the difference of proportions). No or mild pain at insertion was reported by 37% and 35% of subjects in the misoprostol and placebo groups, respectively. However, adverse events related to the study drug were more common in the misoprostol group. Sublingual misoprostol did not have a significant effect on the ease of insertion in subjects having a repeat insertion of the LNG-IUS.Contraception 06/2010; 81(6):481-6. · 2.72 Impact Factor -
Article: The effect of hysterectomy or levonorgestrel-releasing intrauterine system on lower abdominal pain and back pain among women treated for menorrhagia: a five-year randomized controlled trial.
[show abstract] [hide abstract]
ABSTRACT: The purpose of this study was to evaluate the changes in lower abdominal pain and back pain among women with menorrhagia treated by hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS). A randomized controlled trial. Five university hospitals in Finland. A total of 236 women, aged 35-49 years. Women were randomly assigned to treatment by hysterectomy (n = 117) or LNG-IUS (n = 119). Frequency and intensity of lower abdominal pain and back pain were evaluated by questionnaires at baseline and after 6 months, 12 months and 5 years. By six months, women in both groups had less frequent back pain than before treatment (p < 0.001). Lower abdominal pain decreased only in the hysterectomy group (p = 0.02) with significant differences between the groups. Between 12 months and 5 years, frequency of lower abdominal pain (p = 0.05) and back pain (p = 0.002) decreased more in the LNG-IUS group than in the hysterectomy group. Between baseline and five years, the lower abdominal pain score (including frequency and intensity of pain) decreased in both groups (p < 0.001, p = 0.01). Back pain score decreased only in the LNG-IUS group and the difference between the groups was significant (p = 0.02). However, some women experienced more pain after both treatments than before treatment. In multivariate analyses, LNG-IUS use was associated with a decrease in lower abdominal pain and back pain. In the treatment of menorrhagia, both hysterectomy and LNG-IUS decrease lower abdominal pain. LNG-IUS use, but not hysterectomy, has beneficial effects on back pain.Acta Obstetricia Et Gynecologica Scandinavica 11/2009; 88(12):1389-96. · 1.77 Impact Factor -
Article: Hysteroscopic tubal sterilization: a systematic review of the Essure system.
[show abstract] [hide abstract]
ABSTRACT: To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008. The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare. Women over 30 years, who had been sterilized by the Essure method. Hysteroscopic tubal sterilization using Essure system. Efficacy/effectiveness, adverse events, costs. Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed. The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.Fertility and sterility 05/2009; 94(1):16-9. · 3.97 Impact Factor -
Article: Cost-utility of levonorgestrel intrauterine system compared with hysterectomy and second generation endometrial ablative techniques in managing patients with menorrhagia in the UK.
[show abstract] [hide abstract]
ABSTRACT: To estimate the cost-utility of levonorgestrel intrauterine system (LNG-IUS; Mirena) compared to second generation endometrial ablative techniques [i.e. microwave endometrial ablation (MEA) and thermal balloon endometrial ablation (TBEA)) and hysterectomy in the UK. Clinical and utility data from a 5-year randomised controlled trial comparing LNG-IUS with hysterectomy were combined with further data from published studies to construct a state-transition (Markov) model. The model depicted the movement of patients between health states over 5 years following treatment for menorrhagia. The model was used to estimate the cost-utility of LNG-IUS followed by ablation (L-A); LNG-IUS followed by hysterectomy (L-H); immediate ablation (MEA or TBEA) and immediate hysterectomy in the UK at 2004/2005 prices, from the perspective of the UK's National Health Service (NHS). The expected 5-yearly cost of treating menorrhagia with L-A, L-H, TBEA, MEA and hysterectomy was estimated to be 828 pounds sterling, 1355 pounds sterling, 1679 pounds sterling, 1812 pounds sterling and 2983 pounds sterling per patient respectively and the expected level of health gain to be 4.14, 4.12, 4.13, 4.13 and 4.01 QALYs per patient respectively. LNG-IUS followed by ablation dominated all the alternative treatments. Hysterectomy was dominated by the alternative treatments. Sensitivity analysis found the model to be sensitive to the quality of life data used. Within the model's limitations, LNGIUS followed by ablation appears to offer the NHS a cost-effective treatment for menorrhagia, when compared to immediate surgery, affording the NHS a less expensive treatment modality without detrimental effects on resulting health gain.Current Medical Research and Opinion 08/2007; 23(7):1637-48. · 2.38 Impact Factor -
Article: Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system.
[show abstract] [hide abstract]
ABSTRACT: It has been shown that levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment of menorrhagia. However, the discontinuation rate of LNG-IUS treatment is high, and little is known about the actual reasons intertwining it. We tested the hypothesis that depressive symptoms is the factor responsible for deciding to have a hysterectomy during LNG-IUS treatment. The participants (119 women, ages = 35-49 years) were randomly selected over a 3-year period (1994-1997) to receive the LNG-IUS or a hysterectomy for the treatment of menorrhagia. Depressive symptoms, based on Beck's Depression Inventory measured 6 months after the beginning of the treatment, were related to discontinuation of LNG-IUS use Odds Ratio (OR) = 3.70, 95% Confidence Intervals (CI) 1.55-8.82, p = .003 during a 5-year follow-up. This association was not attenuated after adjustment for other known risk factors. Our findings suggest that diagnosing and treating depression among patients having menstrual problems may improve the continuity of LNG-IUS treatment of menorrhagia.International Journal of Behavioral Medicine 02/2007; 14(2):70-5. · 2.63 Impact Factor -
Article: Managing drug-resistant essential menorrhagia without hysterectomy.
[show abstract] [hide abstract]
ABSTRACT: Menorrhagia is a common disorder that requires plenty of resources. Rapid developments in medical technology have resulted in new management strategies, which are true alternatives to hysterectomy. In many countries the levonorgestrel-releasing intrauterine system (LNG-IUS) and endometrial destruction techniques are available for menorrhagia. Clinicians must answer questions about cost, effectiveness and quality of medical care when choosing the treatment option. This review integrates the results from the latest studies and review articles about LNG-IUS and endometrial destruction techniques by addressing the key clinical issues in menorrhagia. Both LNG-IUS and endometrial ablation seem to be good and effective alternative options to hysterectomy. Although these treatments have relatively high failure rates, the majority of women are satisfied and the cost-effectiveness of these treatments are better than that of hysterectomy. Both treatments have their advantages and disadvantages. Thus far LNG-IUS seems to be more cost-effective than endometrial resection or hysterectomy at 5 years follow-up. However, second generation ablation techniques may offer better cost-effectiveness than the first generation techniques, but the evidence is insufficient.Bailliè re s Best Practice and Research in Clinical Obstetrics and Gynaecology 11/2006; 20(5):681-94. · 1.73 Impact Factor -
Article: [Update on current care guidelines. Examination and treatment of heavy menstrual bleeding].
Duodecim; lääketieteellinen aikakauskirja 02/2006; 122(2):179-82. -
Article: [Irregular gynecological bleeding among young fertile women].
Duodecim; lääketieteellinen aikakauskirja 02/2005; 121(21):2299-304. -
Article: Levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding.
[show abstract] [hide abstract]
ABSTRACT: Menorrhagia is a frequent reason for women to seek medical care and an increasingly common health problem. The levonorgestrel-releasing intrauterine system is an effective medical treatment for menorrhagia. Emerging clinical and research evidence suggests that this new treatment modality has major health benefits. The levonorgestrel-releasing intrauterine system is a cost-effective treatment modality for menorrhagia. The quality of life improves significantly which is comparable to that gained with hysterectomy. The costs are about half those of hysterectomy after 5 years of follow-up. Unscheduled breakthrough bleeding is the most common side effect of the treatment. There are different new theories about the mechanism underlying this problem. Women with endometriosis or fibroids also benefit from this treatment. Because menorrhagia is often a reason for seeking medical attention, it is important to consider the outcomes and costs to provide the most appropriate care. The levonorgestrel-releasing intrauterine system improves health-related quality of life significantly at relatively low cost. It is the most effective medical treatment for menorrhagia and comparable to surgical interventions. The system is not associated with serious complications. Although not all women are successfully treated, about 60% avoid hysterectomy and are satisfied with the treatment. Thus, the levonorgestrel-releasing intrauterine system should be the first line of treatment for heavy menstrual bleeding.Current Opinion in Obstetrics and Gynecology 01/2005; 16(6):487-90. · 2.38 Impact Factor -
Article: A randomized trial among women with heavy menstruation -- impact of a decision aid on treatment outcomes and costs.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the effects of a decision aid for menorrhagia on treatment outcomes and costs over a 12-month follow-up. Randomized trial and pre-trial prospective cohort study. Gynaecology outpatient clinics in 14 Finnish hospitals, 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia. A decision aid booklet explaining menorrhagia and treatment options, mailed to patients before their first clinic appointment. Health related quality of life, psychological well-being, menstrual symptoms, satisfaction with treatment outcome, use and cost of health care services. All study groups experienced overall improvement in health-related quality of life, anxiety, and psychosomatic and menstrual symptoms, but not in sexual life. Treatment in the intervention group was more active than in the control group, with more frequent course of medication and less undecided treatments. However, there were no marked disparities in health outcomes, satisfaction with treatment outcome and costs. Total costs (including productivity loss) per woman because of menorrhagia over the 12-month follow-up were 2760 and 3094 in the intervention and control group, respectively (P = 0.1). The pre-trial group also had a significantly lower rate of uterus saving surgery compared with the control group, but no difference in costs because of menorrhagia treatment. Despite some differences in treatment courses, a decision aid for menorrhagia in booklet form did not increase the use of health services or treatment costs, nor had it impact on health outcomes or satisfaction with outcome of treatment.Health Expectations 01/2005; 7(4):327-37. · 2.32 Impact Factor -
Article: Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: predictors of outcome.
[show abstract] [hide abstract]
ABSTRACT: Levonorgestrel-releasing intrauterine system (LNG-IUS) has been advocated as an effective alternative to hysterectomy in the treatment of menorrhagia. The outcome predictors have been poorly known. In this study the amount of menstrual blood loss (MBL) turned out to be the single most important outcome predictor of these treatments. However, the treatment with LNG-IUS seemed to be an appropriate alternative to hysterectomy for all women who perceived their MBL heavy.Acta Obstetricia Et Gynecologica Scandinavica 05/2004; 83(4):401-3. · 1.77 Impact Factor -
Article: Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up.
[show abstract] [hide abstract]
ABSTRACT: Because menorrhagia is often a reason for seeking medical attention, it is important to consider outcomes and costs associated with alternative treatment modalities. Both the levonorgestrel-releasing intrauterine system (LNG-IUS) and hysterectomy have proven effective for treatment of menorrhagia but there are no long-term comparative studies measuring cost and quality of life. To compare outcomes, quality-of-life issues, and costs of the LNG-IUS vs hysterectomy in the treatment of menorrhagia. Randomized controlled trial conducted between October 1, 1994, and October 6, 2002, and enrolling 236 women (mean [SD] age, 43 [3.4] years) referred to 5 university hospitals in Finland for complaints of menorrhagia. Participants were randomly assigned to treatment with the LNG-IUS (n = 119) or hysterectomy (n = 117) and were monitored for 5 years. Health-related quality of life (HRQL) as measured by the 5-Dimensional EuroQol and the RAND 36-Item Short-Form Health Survey, other measures of psychosocial well-being (anxiety, depression, and sexual function), and costs. After 5 years of follow-up, 232 women (99%) were analyzed for the primary outcomes. The 2 groups did not differ substantially in terms of HRQL or psychosocial well-being. Although 50 (42%) of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the discounted direct and indirect costs in the LNG-IUS group (2817 dollars [95% confidence interval, 2222 dollars-3530 dollars] per participant) remained substantially lower than in the hysterectomy group (4660 dollars [95% confidence interval, 4014 dollars-5180 dollars]). Satisfaction with treatment was similar in both groups. By providing improvement in HRQL at relatively low cost, the LNG-IUS may offer a wider availability of choices for the patient and may decrease costs due to interventions involving surgery.JAMA The Journal of the American Medical Association 04/2004; 291(12):1456-63. · 30.03 Impact Factor -
Article: Impact of patient information booklet on treatment decision--a randomized trial among women with heavy menstruation.
[show abstract] [hide abstract]
ABSTRACT: Does a patient information booklet influence treatment for menorrhagia? Randomized trial and a pre-trial prospective cohort study. Gynaecology outpatient clinics in 14 Finnish hospitals. A total of 363 (randomized trial) plus 206 (cohort study) patients with menorrhagia. An information booklet about menorrhagia and treatment options, mailed before the first visit to the outpatient clinic. Distribution of treatment modalities, knowledge about treatment options, satisfaction with communication with personnel and anxiety. Treatment decision within 3 months was made more often in the intervention group than in the control group (96% and 89% respectively, P = 0.02). Oral medication was more frequently chosen, and newly introduced treatments (minor surgery, hormonal intrauterine system) were less frequently used in the intervention group (at 3-month follow-up 21% and 29%, respectively). The differences persisted at the 12-month follow-up. In the pre-trial group, new treatment methods were less frequently chosen and used than in the control group. Additional information did not increase the number of surgical procedures used, improve knowledge, or influence satisfaction or anxiety. Additional information led to an increase in specific treatment decisions and changed the distribution of used treatments without increasing the number of surgical procedures. The study suggests that well-informed women adopting an active role may counteract physicians' emphasis on newly introduced treatments.Health Expectations 01/2004; 6(4):290-7. · 2.32 Impact Factor -
Article: Combined laboratory and diary method for objective assessment of menstrual blood loss
Acta Obstetricia Et Gynecologica Scandinavica 06/2003; 77(2):201 - 204. · 1.77 Impact Factor -
Article: Hysterectomy trends in Finland in 1987‐1995 ‐ a register based analysis
Acta Obstetricia Et Gynecologica Scandinavica 06/2003; 77(7):770 - 776. · 1.77 Impact Factor -
Article: Factors predicting choice of treatment for menorrhagia in gynaecology outpatient clinics.
[show abstract] [hide abstract]
ABSTRACT: The aim of this prospective study was to investigate factors predicting choice of treatment for excessive menstrual bleeding, with special emphasis on women's pre-treatment preference. A cohort of women with heavy menstruation and their treatment process in gynaecology outpatient clinics were followed-up for 1yr. A total of 383 35-54-yr-old women attending 14 Finnish hospitals participated. They completed a questionnaire before their first outpatient clinic visit, and postal follow-ups were conducted 3 and 12 months later. Information on treatment(s) during the follow-up was taken from medical records and questionnaires. The choice between hysterectomy and conservative treatments, and fulfillment of pre-treatment preference were the main outcome measures. During the 1-yr follow-up, 51% (n=196) of the women underwent hysterectomy and nine were still awaiting it, 12% (n=44) had a minor surgical procedure, 11% (n=41) had oral medication, 9% (n=33) used a hormonal intrauterine system, and nine women changed preventive method. Forty-two women (11%) reported having had no treatment. Data on previous treatments suggested that conservative treatment modalities were under-used. Most of the treatment decisions were made within the first 3-month period. Women's pre-treatment preference was the strongest predictor of chosen treatment. Unemployment, irregular periods and anxiety decreased the probability of a decision for hysterectomy, while pelvic pain and inconvenience due to bleeding increased it. The treatment plan accorded with pre-treatment preference in 72% of the women preferring hysterectomy and in 74% of those preferring a conservative option.Social Science [?] Medicine 05/2003; 56(8):1653-60. · 2.70 Impact Factor -
Article: Correlates of women's preferences for treatment of heavy menstrual bleeding.
[show abstract] [hide abstract]
ABSTRACT: This cross-sectional survey investigated factors associated with treatment preferences of women with menorrhagia. Women (n = 474) aged 35-54 years referred to gynaecology out-patient clinics for menorrhagia were mailed a self-administered questionnaire before their first clinic visit. The main outcome measure was treatment preference. Hysterectomy and conservative treatment (combined with no treatment) were favoured equally often. In a multivariate analysis, completed family size (P = 0.003), menstrual pain (P = 0.02), irregular periods (P = 0.03), and higher age (P = 0.04) predicted hysterectomy preference, as did lower education level (P = 0.001), gynaecologist consultations (P = 0.002), and unemployment (P = 0.03). The psychological factors assessed were not associated with treatment preference. In conclusion, rational considerations regarding stage of reproductive life and severity of symptoms were linked to women's treatment preferences. However, education, employment status and use of specialists' services guided women's preferences even more powerfully than menstrual symptoms and burden caused by them. Doctors should pay more attention to motivating women for a trial of conservative treatment since only half of the women reported previous treatment for their menstrual problem.Patient Education and Counseling 03/2003; 49(2):125-32. · 2.31 Impact Factor
Top co-authors
Top Journals
Institutions
-
2011
-
Stanford University
- Department of Obstetrics and Gynecology
Stanford, CA, USA
-
-
2003–2011
-
Helsinki University Central Hospital
- Department of Obstetrics and Gynaecology
Helsinki, Province of Southern Finland, Finland
-
-
2007
-
National Public Health Institute
Helsinki, Province of Southern Finland, Finland
-
-
2003–2005
-
University of Helsinki
- Department of Obstetrics and Gynaecology
Helsinki, Province of Southern Finland, Finland
-
-
2004
-
University of Tampere
Tampere, Western Finland, Finland
-
