Improved premenstrual syndrome symptoms after NovaSure endometrial ablation.

STUDY OBJECTIVE: To evaluate the change in premenstrual syndrome (PMS) symptoms in women with heavy periods who underwent endometrial ablation. DESIGN: The study used a prospective, single-arm cohort of adult women who were to undergo NovaSure endometrial ablation for heavy menses who also reported symptoms of PMS. A brief baseline survey was done to evaluate menstrual bleeding and baseline PMS symptoms, and two 30-day prospective validated measures of PMS were used. Follow-up surveys were sent at 4 to 6 months and included both the brief survey questions and the validated measures of PMS (Canadian Task Force classification II-3). MEASUREMENTS AND MAIN RESULTS: Thirty-six women with heavy periods who were to undergo endometrial ablation had PMS symptoms and completed all surveys at baseline and follow-up. The mean age was 41.4 years, with a mean body mass index of 26.7. Most (27/36, 75%) had failed hormonal management. All measures of PMS showed significant improvement after endometrial ablation. Self-rating of PMS symptoms on a scale of 0 (none) to 10 (severe) improved from a baseline of 7.4 to a follow-up rating of 3.2 (p <.05). The vast majority of women (35/36, 97%) reported improvement in PMS after undergoing endometrial ablation. Both validated measures of PMS, Daily Symptoms Report and Daily Record of Severity of Symptoms, showed statistically significant improvement in PMS symptoms. CONCLUSION: Women with heavy menses and associated PMS symptoms who undergo NovaSure endometrial ablation showed improvement in PMS symptoms, as well as reduced menstrual bleeding.

The Recurrence of Digital Ulcers in Patients with Systemic Sclerosis after Discontinuation of Oral Treprostinil.

OBJECTIVE: Prior studies investigating the efficacy of oral treprostinil to treat digital ulcers (DU) in systemic sclerosis (SSc)-associated Raynaud phenomenon have yielded conflicting results. In this investigation, we examined whether DU burden increased after patients withdrew from oral treprostinil that was administered during an open-label extension study. METHODS: A multicenter, retrospective study was conducted to determine DU burden in the year after withdrawal from oral treprostinil. DU burden 3-6 months (Time A) and > 6-12 months (Time B) after drug withdrawal was compared with DU burden at baseline, defined as the last day receiving drug in the open-label extension study, by a paired Student t test. Changes in DU burden while receiving drug in the open-label study were compared with changes in DU burden at Time B by a paired Student t test. RESULTS: Fifty-one patients from 9 clinical sites were included for analysis. DU burden increased significantly from baseline (mean 0.47) to Time A (mean 2.1, p = 0.002, n = 23) and Time B (mean 1.45, p = 0.013, n = 30). Total DU burden decreased during oral treprostinil exposure (mean change -0.6) and then increased by Time B (mean change 1.05, p = 0.0027 for comparison, n = 30). In the year after drug withdrawal, many patients required vasodilator therapy and pain medications. Three patients were hospitalized for complications from DU, and 4 patients required surgery for DU. CONCLUSION: Total DU burden increased significantly after discontinuation of oral treprostinil. These data provide supportive evidence of a beneficial effect of oral treprostinil for the vascular complications of SSc and suggest that further study is warranted.