{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:44:50Z","timestamp":1771980290642,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T00:00:00Z","timestamp":1477008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD060503"],"award-info":[{"award-number":["R01 HD060503"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 RR024150"],"award-info":[{"award-number":["UL1 RR024150"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To report patterns and patient characteristics associated with initiation of and persistence with medical therapies for uterine fibroid\u2010related heavy menstrual bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">US<\/jats:styled-content> commercial insurance claims database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>41\u00a0561 women aged 18\u201354\u00a0years with uterine fibroids and heavy menstrual bleeding who initiated medical therapies from January 2000 through December 2013.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Multinomial logistic regression was used to assess patient characteristics associated with initiation and persistence. Cox proportional hazards regression was used on propensity score\u2010matched cohorts to examine change from index medication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes measures<\/jats:title><jats:p>Initiation of and persistence with four first\u2010line medical therapies: short\u2010 and long\u2010acting reversible contraceptive steroids, leuprolide acetate, and tranexamic acid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most women (79.4%) took short\u2010acting reversible contraceptive steroids as first\u2010line therapy (<jats:italic>index medication<\/jats:italic>), whereas 9.5%, 8.5%, and 2.7% used long\u2010acting reversible contraceptive steroids, leuprolide acetate, and tranexamic acid, respectively. During follow\u2010up, 16\u00a0594 women (39.9%) switched to nonindex medication (18.4%) or procedural treatment (81.6%). In comparison with women taking short\u2010acting steroids, those receiving long\u2010acting steroids were less likely to switch [hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) 0.84, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.79\u20130.91], whereas women taking leuprolide acetate (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 2.44, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.27\u20132.62) or tranexamic acid (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 1.44, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.26\u20131.65) were more likely to switch. Older age, emergency department visits, anaemia, and inflammatory disease diagnoses at baseline were associated with increased probability of discontinuing the index medication or switching to another therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women with uterine fibroid\u2010related heavy menstrual bleeding were more likely to persist with their initial therapy of long\u2010acting reversible contraceptive steroid compared with other medical options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable Abstract<\/jats:title><jats:p>80% women with fibroid\u2010related heavy menstrual bleeding use <jats:styled-content style=\"fixed-case\">SARC<\/jats:styled-content>, but <jats:styled-content style=\"fixed-case\">LARC<\/jats:styled-content> users are more persistent.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14383","type":"journal-article","created":{"date-parts":[[2016,10,22]],"date-time":"2016-10-22T04:02:53Z","timestamp":1477108973000},"page":"322-330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Medical therapies for heavy menstrual bleeding in women with uterine fibroids: a retrospective analysis of a large commercially insured population in the <scp>USA<\/scp>"],"prefix":"10.1111","volume":"124","author":[{"given":"X","family":"Yao","sequence":"first","affiliation":[{"name":"Division of Health Care Policy and Research Mayo Clinic Rochester MN USA"},{"name":"The Robert D. and Patricia E. 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