Hemoglobin levels predict quality of life in women with heavy menstrual bleeding.

OBJECTIVE: This study was designed to evaluate the effects of heavy menstrual bleeding (HMB) on the quality of life (QoL). METHODS: A prospective, observational study was conducted including 58 patients with HMB, aged 35 years or older, with a negative pregnancy test result, menstrual blood loss >80 ml, uterine volume up to 200 cc and negative endometrial biopsy. The QoL was evaluated by interview using the Short Form-36 (SF-36) questionnaire. Blood loss, measured by Pictorial Blood Loss Assessment Chart (PBAC), and hemoglobin levels were also assessed. Statistical analysis was performed using the Pearson coefficient correlation test. RESULTS: The age of the patients ranged from 35 to 52 years (42.8+/-0.2 years). Increase in monthly expenses, negative implications in conjugal life, work impairment and health-care utilization due to HMB were seen in 96.5, 94.7, 66.7 and 59.6% of the patients, respectively. Hemoglobin levels correlated to SF-36 physical and mental composites scores (p=0.020 and p=0.027, respectively). PBAC score was not correlated with the QoL (physical composite score: p=0.222 and mental composite score: p=0.642) or with hemoglobin levels (r=-0.065; p=0.278). Hemoglobin and QoL showed significant improvement after treatment (p<0.001). Hemoglobin level was the only independent predictor of the QoL measured by SF-36 physical (p=0.03) and mental (p=0.04) composites scores. CONCLUSIONS: HMB had significant repercussions in the social, medical and economic aspects of women. The impact on the QoL was associated with the hematimetric parameters.

Pregnancy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei.

Pseudomyxoma peritonei is usually a benign tumor that is slightly more common in women. However, it requires aggressive surgical treatment and chemotherapy, often compromising future reproductive function. This report presents a case of pregnancy in a 35-year-old woman who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei. The tumor was diagnosed during a laparoscopic examination on a workup for infertility in 2008. Two months later, she underwent a peritonectomy followed by hyperthermic intraperitoneal chemotherapy and, regarding her will to conceive, ovaries and fallopian tubes were preserved. In March 2011, she went through an in vitro fertilization followed by an uneventful pregnancy and delivered a healthy child 39 weeks later. Ovaries are usually resected during the cytoreductive surgery, since they are common sites for neoplastic implants, and, even when not performed, little is known about the effects of local chemotherapy on female fertility. The largest international survey on this matter only describes seven similar cases. This particular report not only describes a rare condition but also adds to the upcoming discussion about whether ovaries can be preserved in specific situations, therefore keeping the prospect of conceiving after this treatment.