title: 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.
  
  
  METHODS
  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.
authors.affiliation: Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA.
authors.forename: Ronda
authors.initials: R
authors.lastname: Copher
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Le Nestour
authors.forename: Amy
authors.initials: A
authors.lastname: Law
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pocoski
authors.forename: Edio
authors.initials: E
authors.lastname: Zampaglione
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007345:Insurance Claim Review; D008595:Menorrhagia / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D045167:Progesterone Congeners / Q000627:therapeutic use; D012189:Retrospective Studies; D014481:United States; D063186:Uterine Myomectomy / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D045167:Progesterone Congeners