Abstract

Objective: To validate a scoring system aims to triage individuals with Heavy Menstrual Bleeding (HMB) into hysterectomy or uterine sparing options and inform the development of a prospective clinical trial.

Design: Retrospective study.

Methods: 327 women aged 25–54 referred with HMB between January 2021 and December 2021 were identified; data was retrieved from patients’ records and divided by outcome. The score was applied to the collected data and patients were followed for two years. The score has 6 parameters (pelvic pain/endometriosis, adenomyosis, fibroid(s), large endometrial cavity, anemia needing parenteral therapy, desire
for hysterectomy), each score 1, apart from uterine cavity length scores 2. Differences and associations between variables were examined.

Sensitivity and specificity of the scoring tool was measured.
Results: 38/327 (11.6%) of patients had hysterectomy. Demographic and clinical variables were divided by outcome. There was a significant association between having each factor of the score and hysterectomy and a significant association of having a total score of ≥3 and
hysterectomy or 6.23 [95%CI 4.80–7.67]. The score has a calculated sensitivity of 0.84 [0.68–0.93], specificity of 0.99 [0.97–0.99] and positive predictive value of 0.91 [0.75–0.98]. A series of logistic regression models was constructed to determine which factors predict hysterectomy
using the six members of the score (and to determine their combined effect). The strongest predictive factor for hysterectomy was large endometrial cavity, followed by woman’s desire for hysterectomy, then adenomyosis (p<0.001). Other demographic and clinical variables
did not predict hysterectomy as an outcome with the exception of dysmenorrhea alone. However, adding this to the score construct did not improve performance, resulting in reduction in the positive predictive value of the measure.
Conclusion: This scoring system as developed has high sensitivity and specificity in triaging women with HMB into hysterectomy and uterine sparing modalities. Further evaluation in a prospective clinical trial is warranted.

Keywords: Heavy menstrual bleeding, Validation, Scoring system