{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:25:21Z","timestamp":1783477521923,"version":"3.55.0"},"reference-count":30,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P51 OD011092"],"award-info":[{"award-number":["P51 OD011092"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012095","name":"Scottish Government","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012095","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G1002033 2011\u20132016"],"award-info":[{"award-number":["G1002033 2011\u20132016"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/J003611\/1"],"award-info":[{"award-number":["MR\/J003611\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N022556\/1 2016\u20132021"],"award-info":[{"award-number":["MR\/N022556\/1 2016\u20132021"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008143","name":"Oregon National Primate Research Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008143","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107049\/Z\/15\/Z https:\/\/wellcome.org\/grant-funding"],"award-info":[{"award-number":["107049\/Z\/15\/Z https:\/\/wellcome.org\/grant-funding"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["thelancet.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["eBioMedicine"],"published-print":{"date-parts":[[2021,7]]},"DOI":"10.1016\/j.ebiom.2021.103434","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T23:56:34Z","timestamp":1625183794000},"page":"103434","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":25,"special_numbering":"C","title":["Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM)"],"prefix":"10.1016","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2239-4827","authenticated-orcid":false,"given":"Pamela","family":"Warner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7678-6551","authenticated-orcid":false,"given":"Lucy Harriet Ravenscroft","family":"Whitaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Anthony","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher John","family":"Weir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Douglas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Holm","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayank","family":"Madhra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Gilbert","family":"Hillier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa Tansy Kemp","family":"Saunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Peter","family":"Iredale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Semple","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ov Daniel","family":"Slayden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian Robert","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary Octavia Dawn","family":"Critchley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ebiom.2021.103434_bib0001","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1016\/j.jclinepi.2005.02.026","article-title":"A Scottish postal survey suggested that prevailing clinical pre-occupation with heavy periods does not reflect the epidemiology of reported symptoms and problems","volume":"58","author":"Santer","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0002","first-page":"359","article-title":"An epidemiological survey of symptoms of menstrual loss in the community","volume":"54","author":"Shapley","year":"2004","journal-title":"BJGP"},{"key":"10.1016\/j.ebiom.2021.103434_bib0003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta15190","article-title":"Hysterectomy, endometrial ablation and Mirena(R) for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis","volume":"15","author":"Bhattacharya","year":"2011","journal-title":"Health Technol Assess"},{"key":"10.1016\/j.ebiom.2021.103434_bib0004","series-title":"London school of hygiene & tropical medicine, ipsos MORI. national heavy menstrual bleeding audit: first annual report","year":"2011"},{"key":"10.1016\/j.ebiom.2021.103434_bib0005","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1471-0528.2004.00012.x","article-title":"Epidemiology of menstrual disorders in developing countries: a systematic review","volume":"111","author":"Harlow","year":"2004","journal-title":"BJOG"},{"key":"10.1016\/j.ebiom.2021.103434_bib0006","series-title":"Heavy menstrual bleeding","year":"2007"},{"issue":"4","key":"10.1016\/j.ebiom.2021.103434_bib0007","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1080\/23293691.2018.1523116","article-title":"Neglect of menstrual disorders in reproductive health care in India: a population-based survey","volume":"5","author":"Anand","year":"2018","journal-title":"Women's Reprod. Health"},{"key":"10.1016\/j.ebiom.2021.103434_bib0008","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40834-017-0047-4","article-title":"Heavy menstrual bleeding diagnosis and medical management","volume":"2","author":"Sriprasert","year":"2017","journal-title":"Contracept Reprod Med."},{"key":"10.1016\/j.ebiom.2021.103434_bib0009","article-title":"Case discussion: heavy menstrual bleeding in primary care and beyond","volume":"2","author":"Kaloo","year":"2014","journal-title":"Br J Family Med."},{"key":"10.1016\/j.ebiom.2021.103434_bib0010","unstructured":"Period poverty Scotland https:\/\/www.economist.com\/britain\/2020\/02\/27\/free-period-products-in-scotland, Accessed Sep 2020"},{"key":"10.1016\/j.ebiom.2021.103434_bib0011","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/ijgo.12666","article-title":"The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions","volume":"143","author":"Munro","year":"2018","journal-title":"Int J Gynecol Obstet"},{"issue":"3","key":"10.1016\/j.ebiom.2021.103434_bib0012","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/AOG.0b013e3182839e0e","article-title":"Non-surgical management of heavy menstrual bleeding: a systematic review and practice guidelines","volume":"121","author":"K A Matteson","year":"2013","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0013","series-title":"London school of hygiene & tropical medicine, IPSOS MORI. National heavy menstrual bleeding audit: third annual report","year":"2013"},{"key":"10.1016\/j.ebiom.2021.103434_bib0014","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1210\/jc.2008-1879","article-title":"Cortisol inactivation by 11beta-hydroxysteroid dehydrogenase-2 may enhance endometrial angiogenesis via reduced thrombospondin-1 in heavy menstruation","volume":"94","author":"Rae","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"10.1016\/j.ebiom.2021.103434_bib0015","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1152\/physrev.00031.2019","article-title":"Physiology of the endometrium and regulation of menstruation","volume":"100","author":"Critchley","year":"2020","journal-title":"Physiol Rev"},{"issue":"1","key":"10.1016\/j.ebiom.2021.103434_bib0016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-006837","article-title":"Low-dose dexamethasone as a treatment for women with heavy menstrual bleeding: protocol for response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM)","volume":"5","author":"Warner","year":"2015","journal-title":"BMJ Open"},{"key":"10.1016\/j.ebiom.2021.103434_bib0017","doi-asserted-by":"crossref","first-page":"2681","DOI":"10.1177\/0962280215606155","article-title":"Development of a Bayesian response-adaptive trial design for the Dexamethasone for Excessive Menstruation study","volume":"26","author":"Hansen","year":"2017","journal-title":"Stat Methods Med Res"},{"key":"10.1016\/j.ebiom.2021.103434_bib0018","first-page":"1216","article-title":"Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data","volume":"190","author":"Warner","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0019","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0015-0282(01)01847-7","article-title":"Determination of total menstrual blood loss","volume":"76","author":"Wyatt","year":"2001","journal-title":"Fertil Steril"},{"key":"10.1016\/j.ebiom.2021.103434_bib0020","first-page":"1224","article-title":"Menorrhagia II: is the 80-mL blood loss criterion useful in management of complaint of menorrhagia?","volume":"190","author":"Warner","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0021","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/AOG.0b013e3181f20177","article-title":"Tranexamic acid treatment for heavy menstrual bleeding A randomized controlled trial","volume":"116","author":"Lukes","year":"2010","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0022","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jclinepi.2010.03.017","article-title":"Systematic review highlights difficulty interpreting diverse clinical outcomes in abnormal uterine bleeding trials","volume":"64","author":"Rahn","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.ebiom.2021.103434_bib0023","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/bmj.323.7303.24","article-title":"Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management","volume":"323","author":"Warner","year":"2001","journal-title":"BMJ"},{"key":"10.1016\/j.ebiom.2021.103434_bib0024","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1472-6874-7-8","article-title":"What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study","volume":"7","author":"Santer","year":"2007","journal-title":"BMC Womens Health"},{"key":"10.1016\/j.ebiom.2021.103434_bib0025","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1185\/03007995.2010.526098","article-title":"Estimating a meaningful reduction in menstrual blood loss for women with heavy menstrual bleeding","volume":"26","author":"Lukes","year":"2010","journal-title":"Curr Med Res Opin"},{"issue":"3","key":"10.1016\/j.ebiom.2021.103434_bib0026","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF03256762","article-title":"Adaptive approaches in clinical drug development. opportunities and challenges in design and implementation","volume":"23","author":"Krams","year":"2009","journal-title":"Pharm Med"},{"key":"10.1016\/j.ebiom.2021.103434_bib0027","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/1352458510382129","article-title":"A novel adaptive design strategy increases the efficiency of clinical trials in secondary progressive multiple sclerosis","volume":"17","author":"Chataway","year":"2011","journal-title":"Mult Scler"},{"key":"10.1016\/j.ebiom.2021.103434_bib0028","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/hrt.2003.020180","article-title":"Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population-based case-control study","volume":"90","author":"Souverain","year":"2004","journal-title":"Heart"},{"key":"10.1016\/j.ebiom.2021.103434_bib0029","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1359\/jbmr.2000.15.6.993","article-title":"Use of oral corticosteroids and risk of fractures","volume":"15","author":"van Staa","year":"2000","journal-title":"J Bone Miner Res"},{"issue":"2","key":"10.1016\/j.ebiom.2021.103434_bib0030","first-page":"240","article-title":"The clinical use of steroids in pregnancy","volume":"22","author":"Kemp","year":"2016","journal-title":"Hum. Reprod. Update"}],"container-title":["eBioMedicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2352396421002279?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2352396421002279?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T19:08:55Z","timestamp":1762456135000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2352396421002279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":30,"alternative-id":["S2352396421002279"],"URL":"https:\/\/doi.org\/10.1016\/j.ebiom.2021.103434","relation":{},"ISSN":["2352-3964"],"issn-type":[{"value":"2352-3964","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM)","name":"articletitle","label":"Article Title"},{"value":"eBioMedicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ebiom.2021.103434","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"103434"}}