Dysfunctional uterine bleeding future or investigational therapies: Difference between revisions

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==Overview==
==Overview==
Abnormal uterine bleeding has been found to affect a multitude of women, ranging from menarche to menopause. It can often result in conditions that affect an individual's daily routine and personal life, such as anemia and infertility. Because of such complications, it is important to continue researching and studying the causes of abnormal bleeding and providing further knowledge.<ref name="pmid28716637">{{cite journal| author=Levy-Zauberman Y, Pourcelot AG, Capmas P, Fernandez H| title=Update on the management of abnormal uterine bleeding. | journal=J Gynecol Obstet Hum Reprod | year= 2017 | volume= 46 | issue= 8 | pages= 613-622 | pmid=28716637 | doi=10.1016/j.jogoh.2017.07.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28716637  }} </ref> Due to the prevalence and high cost associated with surgical treatment of underlying causes, treatment must be tailored to the individual woman. Biomarkers continue to be studied and may provide crucial information.<ref name="pmid30388215">{{cite journal| author=Chodankar R, Critchley HOD| title=Biomarkers in abnormal uterine bleeding†. | journal=Biol Reprod | year= 2019 | volume= 101 | issue= 6 | pages= 1155-1166 | pmid=30388215 | doi=10.1093/biolre/ioy231 | pmc=6931000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30388215  }} </ref>
Abnormal uterine bleeding has been found to affect a multitude of women, ranging from menarche to menopause. It can often result in conditions that affect an individual's daily routine and personal life, such as anemia and infertility. Because of such complications, it is important to continue researching and studying the causes of abnormal bleeding and providing further knowledge.<ref name="pmid28716637">{{cite journal| author=Levy-Zauberman Y, Pourcelot AG, Capmas P, Fernandez H| title=Update on the management of abnormal uterine bleeding. | journal=J Gynecol Obstet Hum Reprod | year= 2017 | volume= 46 | issue= 8 | pages= 613-622 | pmid=28716637 | doi=10.1016/j.jogoh.2017.07.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28716637  }} </ref> Due to the prevalence and high cost associated with surgical treatment of underlying causes, treatment must be tailored to the individual woman. Biomarkers continue to be studied and may provide crucial information.<ref name="pmid30388215">{{cite journal| author=Chodankar R, Critchley HOD| title=Biomarkers in abnormal uterine bleeding†. | journal=Biol Reprod | year= 2019 | volume= 101 | issue= 6 | pages= 1155-1166 | pmid=30388215 | doi=10.1093/biolre/ioy231 | pmc=6931000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30388215 }} </ref> Future studied regarding  progesterone antagonists and  progesterone receptor modulators are also being studied and may proove helpful in future therapy. <ref name="pmid17584533">{{cite journal| author=Samuel NC, Clark TJ| title=Future research into abnormal uterine bleeding. | journal=Best Pract Res Clin Obstet Gynaecol | year= 2007 | volume= 21 | issue= 6 | pages= 1023-40 | pmid=17584533 | doi=10.1016/j.bpobgyn.2007.03.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17584533 }}</ref>


==Future or Investigational Therapies==
==Future or Investigational Therapies==
===Biomarkers===<ref name="pmid30388215">{{cite journal| author=Chodankar R, Critchley HOD| title=Biomarkers in abnormal uterine bleeding†. | journal=Biol Reprod | year= 2019 | volume= 101 | issue= 6 | pages= 1155-1166 | pmid=30388215 | doi=10.1093/biolre/ioy231 | pmc=6931000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30388215  }} </ref>
 
=== Biomarkers<ref name="pmid30388215">{{cite journal| author=Chodankar R, Critchley HOD| title=Biomarkers in abnormal uterine bleeding†. | journal=Biol Reprod | year= 2019 | volume= 101 | issue= 6 | pages= 1155-1166 | pmid=30388215 | doi=10.1093/biolre/ioy231 | pmc=6931000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30388215  }} </ref> ===
A biomarker is an indicator that may be measured and used as an indicator for treatment response. Biomarers have been studied for underlying conditions leading to abnormal bleeding.
A biomarker is an indicator that may be measured and used as an indicator for treatment response. Biomarers have been studied for underlying conditions leading to abnormal bleeding.
{| class="wikitable"
|+Biomarkers
!Cause of Abnormal Bleeding
!Associated Biomarkers
|-
|Polyps
|
* no identified biomarkers
|-
|Adenomyosis
|
* Caveolin (CAV) proteins: a loss of CAV1 had been seen to contribute to the pathogenesis of Adenomyosis
* Moesin: higher levels noted in patients affected by Adenomyosis
|-
|Leiomyoma/ Fibroids
|
* WNT/β-catenin pathway: commonly associated with fibroid growth
* HMG2A: associated with chromosomal rearrangements
* Transforming growth factor-beta 3 (TGF-β3): secreted by fibroids
* Upregulation of cytokines such as interleukins IL 10,13, and 1
|-
|Coagulopathy <ref name="pmid30609040">{{cite journal| author=Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee| title=Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.]. | journal=Int J Gynaecol Obstet | year= 2019 | volume= 144 | issue= 2 | pages= 237 | pmid=30609040 | doi=10.1002/ijgo.12709 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30609040  }}</ref>
|
* CBC
* D-Dimer
* Fibrinogen
* INR
* PT
* PTT
* Platelet function test
* Ristocetin cofactor
* Von Willebrand factor antigen
|-
|Ovulatory disorders
|
* Serum amyloid protein A (SAA) may be used to differentiate between ovulatory and non-ovulatory causes
|-
|Endometrial disorders
|
* Metalloproteases: increased levels seen in endometrial conditions
|}
=== Elastography ===
Elastography, a type of medical imaging done using MRI and ultrasonography, is used as a noninvasive biomarker for fibroids and adenomyosis. They show promise in allowing for individualized care and treatment response.<ref name="pmid28952003">{{cite journal| author=Jondal DE, Wang J, Chen J, Gorny KR, Felmlee J, Hesly G | display-authors=etal| title=Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography. | journal=Abdom Radiol (NY) | year= 2018 | volume= 43 | issue= 6 | pages= 1456-1463 | pmid=28952003 | doi=10.1007/s00261-017-1314-1 | pmc=6731767 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28952003  }}</ref> 


==References==
==References==

Revision as of 07:15, 18 March 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Arooj Naz

Overview

Abnormal uterine bleeding has been found to affect a multitude of women, ranging from menarche to menopause. It can often result in conditions that affect an individual's daily routine and personal life, such as anemia and infertility. Because of such complications, it is important to continue researching and studying the causes of abnormal bleeding and providing further knowledge.[1] Due to the prevalence and high cost associated with surgical treatment of underlying causes, treatment must be tailored to the individual woman. Biomarkers continue to be studied and may provide crucial information.[2] Future studied regarding progesterone antagonists and progesterone receptor modulators are also being studied and may proove helpful in future therapy. [3]

Future or Investigational Therapies

Biomarkers[2]

A biomarker is an indicator that may be measured and used as an indicator for treatment response. Biomarers have been studied for underlying conditions leading to abnormal bleeding.

Biomarkers
Cause of Abnormal Bleeding Associated Biomarkers
Polyps
  • no identified biomarkers
Adenomyosis
  • Caveolin (CAV) proteins: a loss of CAV1 had been seen to contribute to the pathogenesis of Adenomyosis
  • Moesin: higher levels noted in patients affected by Adenomyosis
Leiomyoma/ Fibroids
  • WNT/β-catenin pathway: commonly associated with fibroid growth
  • HMG2A: associated with chromosomal rearrangements
  • Transforming growth factor-beta 3 (TGF-β3): secreted by fibroids
  • Upregulation of cytokines such as interleukins IL 10,13, and 1
Coagulopathy [4]
  • CBC
  • D-Dimer
  • Fibrinogen
  • INR
  • PT
  • PTT
  • Platelet function test
  • Ristocetin cofactor
  • Von Willebrand factor antigen
Ovulatory disorders
  • Serum amyloid protein A (SAA) may be used to differentiate between ovulatory and non-ovulatory causes
Endometrial disorders
  • Metalloproteases: increased levels seen in endometrial conditions

Elastography

Elastography, a type of medical imaging done using MRI and ultrasonography, is used as a noninvasive biomarker for fibroids and adenomyosis. They show promise in allowing for individualized care and treatment response.[5]

References

  1. ↑ Levy-Zauberman Y, Pourcelot AG, Capmas P, Fernandez H (2017). "Update on the management of abnormal uterine bleeding". J Gynecol Obstet Hum Reprod. 46 (8): 613–622. doi:10.1016/j.jogoh.2017.07.005. PMID 28716637.
  2. ↑ 2.0 2.1 Chodankar R, Critchley HOD (2019). "Biomarkers in abnormal uterine bleeding†". Biol Reprod. 101 (6): 1155–1166. doi:10.1093/biolre/ioy231. PMC 6931000 Check |pmc= value (help). PMID 30388215.
  3. ↑ Samuel NC, Clark TJ (2007). "Future research into abnormal uterine bleeding". Best Pract Res Clin Obstet Gynaecol. 21 (6): 1023–40. doi:10.1016/j.bpobgyn.2007.03.018. PMID 17584533.
  4. ↑ Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee (2019). "Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.]". Int J Gynaecol Obstet. 144 (2): 237. doi:10.1002/ijgo.12709. PMID 30609040.
  5. ↑ Jondal DE, Wang J, Chen J, Gorny KR, Felmlee J, Hesly G; et al. (2018). "Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography". Abdom Radiol (NY). 43 (6): 1456–1463. doi:10.1007/s00261-017-1314-1. PMC 6731767 Check |pmc= value (help). PMID 28952003.

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