33 PROMs in autosomal inherited bleeding disorders: A systematic literature review 2 Four studies reported a high prevalence of dysmenorrhea in women with heavy menstrual bleeding 29,30,32,39, and two studies evaluated the influence of treatment for heavy menstrual bleeding and dysmenorrhea on HRQoL 29,30. The study by Chi et al. used a combination of therapies including tranexamic acid, oral contraceptive pill, desmopressin nasal spray and factor concentrates 29, whereas Hug et al. used an ablative procedure as treatment for heavy menstrual bleeding 30. Both studies found that treatment improved general health, daily activity, dysmenorrhea, interference of dysmenorrhea with daily work and overall HRQoL 29,30 (Table 3). Association of bleeding scores and health-related quality of life Five publications assessed the correlation between bleeding assessment tools scores and HRQoL 23-25,40,42. Bleeding scores were determined using validated tools including the Tosetto Bleeding Score 24,25,42, the International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) 23,40 and the self-administered Bleeding Assessment Tool (Self-BAT) 40. Three studies found that a more severe bleeding phenotype (i.e. higher bleeding scores) was associated with lower HRQoL 24,25,42, two studies did not find such an association 23,40. Higher bleeding scores were associated with lower scores on physical and social functioning, bodily pain and general health in both children and adult patients with VWD 24,25. One study adjusted for age, gender, comorbidity, employment and educational status and still found significantly lower HRQoL scores in patients with higher bleeding scores 25.
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