title: Qualitative cross-cultural exploration of vaginal bleeding/spotting symptoms and impacts associated with hormone therapy in post-menopausal women to inform the development of new patient-reported measurement tools.
abstract: OBJECTIVE
  To understand the vaginal bleeding/spotting experiences of postmenopausal (PM) women taking estrogen plus progestin therapies (EPT) and develop measures to assess these symptoms and their impact on women's daily lives in four countries.
  
  
  METHODS
  (1) Concept elicitation interviews were conducted with PM women in the US (n=14), Italy (n=15), Mexico (n=15) and China (n=15) to explore vaginal bleeding/spotting symptoms associated with EPT. The Post-Menopausal Bleeding Questionnaire (PMBQ) was also debriefed to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a single item electronic daily diary was developed and the PMBQ modified to form a 12-item impact measure. (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis.
  
  
  METHODS
  The Vaginal Bleeding/Spotting Daily Diary, (VBS-DD) and Post-Menopausal Bleeding Impact Questionnaire (PMBIQ) were developed in this study.
  
  
  RESULTS
  Concept elicitation identified vaginal bleeding and spotting as important symptoms for women taking EPT, impacting their emotional wellbeing, social life, ability to move freely, clothing and sexual activity. Based on pilot testing and cognitive debriefing, women demonstrated good understanding of the VBS-DD and the PMBQ was reduced to 10 items due to conceptual redundancy.
  
  
  CONCLUSIONS
  Women taking EPT in the US, China, Mexico and Italy reported vaginal bleeding/spotting symptoms that have a detrimental impact on their quality of life. Two new measures were developed to assess the severity and impact of vaginal bleeding/spotting specific to EPT. This work highlights the need for EPT-related symptoms to be a part of treatment decision-making.
authors.affiliation: Adelphi Values, Adelphi Mill, Bollington, Cheshire SK10 5JB, UK. Electronic address: rob.arbuckle@adelphivalues.com.
authors.forename: Rob
authors.initials: R
authors.lastname: Arbuckle
authors.affiliation: Adelphi Values, Adelphi Mill, Bollington, Cheshire SK10 5JB, UK. Electronic address: lhumphrey@abacusint.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Humphrey
authors.affiliation: Pfizer Ltd, Dorking Road, Tadworth, Kent KT20 7NS, UK. Electronic address: Lucy.Abraham@pfizer.com.
authors.forename: Lucy
authors.initials: L
authors.lastname: Abraham
authors.affiliation: University of Melbourne, Australia. Electronic address: lorrdenn@aol.com.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dennerstein
authors.affiliation: George Washington University, Washington, DC, USA. Electronic address: jsimon@JamesASimonMD.com.
authors.forename: James A
authors.initials: JA
authors.lastname: Simon
authors.affiliation: Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA. Electronic address: sebastian.mirkin@pfizer.com.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mirkin
authors.affiliation: Adelphi Values, Adelphi Mill, Bollington, Cheshire SK10 5JB, UK. Electronic address: Nicola.bonner@adelphivalues.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Bonner
authors.affiliation: Adelphi Values, Adelphi Mill, Bollington, Cheshire SK10 5JB, UK. Electronic address: S.Walmsley@uws.edu.au.
authors.forename: Steven
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: Adelphi Values, Adelphi Mill, Bollington, Cheshire SK10 5JB, UK. Electronic address: sophi.tatlock@adelphivalues.com.
authors.forename: Sophi
authors.initials: S
authors.lastname: Tatlock
authors.affiliation: Pfizer Ltd, Dorking Road, Tadworth, Kent KT20 7NS, UK. Electronic address: tara.symonds@pfizer.com.
authors.forename: Tara
authors.initials: T
authors.lastname: Symonds
mesh_terms: D000328:Adult; D002681:China; D003469:Culture; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004967:Estrogens / Q000494:pharmacology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D008796:Metrorrhagia / Q000209:etiology*; D008800:Mexico; D008875:Middle Aged; D017698:Postmenopause; D036301:Qualitative Research; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States; D014592:Uterine Hemorrhage / Q000209:etiology*; D014621:Vagina / Q000187:drug effects
chemical_list: D004967:Estrogens
keywords: Cross-cultural; Patient-reported outcomes; Post-menopausal; Qualitative research; Questionnaire development; Vaginal bleeding