Retrospective analysis of variation in heavy menstrual bleeding treatments by age and underlying cause

Abstract

Objective:

To describe treatment patterns associated with heavy menstrual bleeding (HMB) in US practice.

Study design:

A retrospective claims-based analysis of organic (ICD-9 codes 218.x, 621.0, 622.7, 219.x, and bleeding disorders) or idiopathic (no underlying condition identified) HMB treatment patterns among newly diagnosed, commercially insured women who were enrolled in a large US health plan. First HMB claim (index date; ICD-9-CM 626.2 and 627.0), second HMB claim within 180 days of index date, and continuous enrollment ≥6 months prior to (pre-index period) and 18 months following (post-index period) index date were required.

Results:

The database included 13,579 organic and 21,362 idiopathic HMB patients. More organic HMB patients received only one treatment type (64% vs 58%; p < 0.001) or two treatments types (14% vs 11%; p < 0.001) compared to idiopathic HMB patients. During the 18 month post-index period, fewer organic HMB patients had no observed treatment compared to idiopathic HMB patients (21% vs 31%; p < 0.001). The idiopathic cohort had significantly higher rates (p < 0.001) of medication use and endometrial ablation, whereas the organic HMB cohort had a higher rate of hysterectomy (p < 0.001). Women <35 years were more frequently prescribed medical treatments (p ≤ 0.037), while women aged >35 years utilized significantly more surgical approaches (p < 0.001).

Conclusions:

Among organic and idiopathic HMB patients, considerable variation was observed in the medications and procedures used to treat HMB. Current treatment pattern awareness may improve HMB management. Future research is needed to understand factors that influence women’s treatment choices (including newer medications LNG-IUS and tranexamic acid) and age in relation to child-bearing preference.

Keywords::

• Excessive menstrual bleeding
• Hypermenorrhea
• Menorrhagia
• Outcomes
• Treatment patterns

Transparency

Declaration of funding

This research was supported by Bayer HealthCare Pharmaceuticals (‘Bayer’), Wayne, NJ, USA. The funding from Bayer was not contingent upon study results.

Declaration of financial/other relationships

E.Z., J.P., and A.L. have disclosed that they are employees of Bayer. When the research was conducted, E.L. was an employee of i3Research (Nanterre, France) and R.C. was an employee of Innovus Life Sciences (Eden Prairie, MN, USA). At the time, both i3Research and Innovus Life Sciences were divisions within the United Healthcare Group (Eden Prairie, MN, USA) that received research funds from Bayer to conduct the research. Since the completion of the research, i3Research was sold and the company’s name changed to PharmaNet/i3. E.L. is currently employed by PharmaNet/i3. Innovus Life Sciences had been renamed OPTUMInsight and remains a division of United Healthcare Group. R.C. is currently employed by Eisai Pharmaceuticals.

CMRO peer reviewers on this manuscript have received honoraria for their review work, but have no other relevant financial relationships to disclose.

All authors had full access to the raw data set and take responsibility for the integrity of the data and the accuracy of the data analysis. The study protocol is available from Amy Law ([email protected]) and the data set is not available.

Acknowledgments

The authors thank Bayer HealthCare Pharmaceuticals employee Alexander Prezioso MD for his contributions to the research and review of this manuscript.

The authors thank the following employees of OPTUMInsight for their assistance with the conduct of the study or preparation of this manuscript: Ying Fan (PhD; lead research analyst), Priyanka Koka (MS; lead programmer analyst), Rui Song (PhD; lead analyst), Jessica Wegner (MA; project manager), Yvette Dennis-Greiner (AS; graphics), Victoria Porter (BA; medical writer), and Laura Oberthur Johnson (PhD; medical writer). Financial support for this research and associated manuscript preparation was provided by Bayer HealthCare Pharmaceuticals to OPTUMInsight.

Previous presentation: An abstract based on this study was presented at American Congress of Obstetrics and Gynecologists 59th Annual Clinical Meeting, April 30–May 4, 2011, in Washington, DC, USA.