Abstract：
BACKGROUND: There is evidence suggesting that COVID-19 vaccination may be associated with small, transitory effects on uterine bleeding, possibly including menstrual timing, flow, and duration, in some individuals. However, changes in health care seeking, diagnosis, and workup for abnormal uterine bleeding in the COVID-19 vaccine era are less clear.
OBJECTIVE: This study aimed to assess the impact of COVID-19 vaccination on incident abnormal uterine bleeding diagnosis and diagnostic evaluation in a large integrated health system.
METHODS: Using segmented regression, we assessed whether the availability of COVID-19 vaccines was associated with changes in monthly, population-based rates of incident abnormal uterine bleeding diagnoses relative to the prepandemic period in health system members aged 16 to 44 years who were not menopausal. We also compared clinical and demographic characteristics of patients diagnosed with incident abnormal uterine bleeding between December 2020 and October 13, 2021 by vaccination status (never vaccinated, vaccinated in the 60 days before diagnosis, vaccinated >60 days before diagnosis). Furthermore, we conducted detailed chart review of patients diagnosed with abnormal uterine bleeding within 1 to 60 days of COVID-19 vaccination in the same time period.
RESULTS: In monthly populations ranging from 79,000 to 85,000 female health system members, incidence of abnormal uterine bleeding diagnosis per 100,000 person-days ranged from 8.97 to 19.19. There was no significant change in the level or trend in the incidence of abnormal uterine bleeding diagnoses between the prepandemic (January 2019-January 2020) and post-COVID-19 vaccine (December 2020-December 2021) periods. A comparison of clinical characteristics of 2717 abnormal uterine bleeding cases by vaccination status suggested that abnormal bleeding among recently vaccinated patients was similar or less severe than abnormal bleeding among patients who had never been vaccinated or those vaccinated >60 days before. There were also significant differences in age and race of patients with incident abnormal uterine bleeding diagnoses by vaccination status (Ps<.02). Never-vaccinated patients were the youngest and those vaccinated >60 days before were the oldest. The proportion of patients who were Black/African American was highest among never-vaccinated patients, and the proportion of Asian patients was higher among vaccinated patients. Chart review of 114 confirmed postvaccination abnormal uterine bleeding cases diagnosed from December 2020 through October 13, 2021 found that the most common symptoms reported were changes in timing, duration, and volume of bleeding. Approximately one-third of cases received no diagnostic workup; 57% had no etiology for the bleeding documented in the electronic health record. In 12% of cases, the patient mentioned or asked about a possible link between their bleeding and their recent COVID-19 vaccine.
CONCLUSIONS: The availability of COVID-19 vaccination was not associated with a change in incidence of medically attended abnormal uterine bleeding in our population of over 79,000 female patients of reproductive age. In addition, among 2717 patients with abnormal uterine bleeding diagnoses in the period following COVID-19 vaccine availability, receipt of the vaccine was not associated with greater bleeding severity.
OBJECTIVE: This study aimed to assess the impact of COVID-19 vaccination on incident abnormal uterine bleeding diagnosis and diagnostic evaluation in a large integrated health system.
METHODS: Using segmented regression, we assessed whether the availability of COVID-19 vaccines was associated with changes in monthly, population-based rates of incident abnormal uterine bleeding diagnoses relative to the prepandemic period in health system members aged 16 to 44 years who were not menopausal. We also compared clinical and demographic characteristics of patients diagnosed with incident abnormal uterine bleeding between December 2020 and October 13, 2021 by vaccination status (never vaccinated, vaccinated in the 60 days before diagnosis, vaccinated >60 days before diagnosis). Furthermore, we conducted detailed chart review of patients diagnosed with abnormal uterine bleeding within 1 to 60 days of COVID-19 vaccination in the same time period.
RESULTS: In monthly populations ranging from 79,000 to 85,000 female health system members, incidence of abnormal uterine bleeding diagnosis per 100,000 person-days ranged from 8.97 to 19.19. There was no significant change in the level or trend in the incidence of abnormal uterine bleeding diagnoses between the prepandemic (January 2019-January 2020) and post-COVID-19 vaccine (December 2020-December 2021) periods. A comparison of clinical characteristics of 2717 abnormal uterine bleeding cases by vaccination status suggested that abnormal bleeding among recently vaccinated patients was similar or less severe than abnormal bleeding among patients who had never been vaccinated or those vaccinated >60 days before. There were also significant differences in age and race of patients with incident abnormal uterine bleeding diagnoses by vaccination status (Ps<.02). Never-vaccinated patients were the youngest and those vaccinated >60 days before were the oldest. The proportion of patients who were Black/African American was highest among never-vaccinated patients, and the proportion of Asian patients was higher among vaccinated patients. Chart review of 114 confirmed postvaccination abnormal uterine bleeding cases diagnosed from December 2020 through October 13, 2021 found that the most common symptoms reported were changes in timing, duration, and volume of bleeding. Approximately one-third of cases received no diagnostic workup; 57% had no etiology for the bleeding documented in the electronic health record. In 12% of cases, the patient mentioned or asked about a possible link between their bleeding and their recent COVID-19 vaccine.
CONCLUSIONS: The availability of COVID-19 vaccination was not associated with a change in incidence of medically attended abnormal uterine bleeding in our population of over 79,000 female patients of reproductive age. In addition, among 2717 patients with abnormal uterine bleeding diagnoses in the period following COVID-19 vaccine availability, receipt of the vaccine was not associated with greater bleeding severity.
摘要：
背景：有证据表明，COVID-19疫苗接种可能与小，对子宫出血的短暂影响，可能包括月经时间，流量,和持续时间，在一些个人。然而,寻求医疗保健的变化，诊断,COVID-19疫苗时代异常子宫出血的检查不太清楚。
目的：评估COVID-19疫苗接种对大型综合卫生系统中异常子宫出血事件诊断和诊断评估的影响。
方法：使用分段回归，我们评估了COVID-19疫苗的可获得性是否与每月的变化有关，在未绝经的16-44岁的卫生系统成员中,与大流行前相比,以人群为基础的异常子宫出血发生率.我们还比较了2020年12月至2021年10月13日期间被诊断为异常子宫出血的患者的临床和人口统计学特征（未接种疫苗，在诊断前60天接种疫苗，在诊断前60天以上接种疫苗），并在同一时间段内对COVID-19疫苗接种后1-60天内被诊断为异常子宫出血的患者进行了详细的图表审查。
结果：在每月79,000至85,000名女性卫生系统成员中，每100,000人天诊断异常子宫出血的发生率为8.97~19.19.在大流行前（2019年1月至2020年1月）和COVID-19疫苗后（2020年12月至2021年12月）期间，异常子宫出血诊断的发生率水平或趋势没有显着变化。通过疫苗接种状态对2,717例异常子宫出血病例的临床特征的比较表明，最近接种疫苗的患者中的异常出血与从未接种疫苗的患者或超过60天之前接种疫苗的患者中的异常出血相似或较不严重。根据疫苗接种状态诊断出异常子宫出血的患者的年龄和种族也存在显着差异：从未接种疫苗的患者最年轻，而60天以上接种疫苗的患者最年长;从未接种疫苗的患者中，黑人/非裔美国人的比例最高。在接种疫苗的患者中，亚洲患者的比例较高。从2020年12月至2021年10月13日诊断的114例确诊的疫苗接种后异常子宫出血病例的图表审查发现，报告的最常见症状是时间变化，持续时间,和出血量。大约三分之一的病例没有接受诊断检查；57％的病例在电子健康记录中没有记录出血的病因。在12%的案例中,患者提到或询问他们的出血与他们最近的COVID-19疫苗之间的可能联系。
结论：在我们超过79,000名育龄女性患者的人群中，COVID-19疫苗接种的可用性与药物治疗异常子宫出血发生率的变化无关。此外,在COVID-19疫苗上市后的2717例异常子宫出血患者中，接种疫苗与出血严重程度无关.
目的：评估COVID-19疫苗接种对大型综合卫生系统中异常子宫出血事件诊断和诊断评估的影响。
方法：使用分段回归，我们评估了COVID-19疫苗的可获得性是否与每月的变化有关，在未绝经的16-44岁的卫生系统成员中,与大流行前相比,以人群为基础的异常子宫出血发生率.我们还比较了2020年12月至2021年10月13日期间被诊断为异常子宫出血的患者的临床和人口统计学特征（未接种疫苗，在诊断前60天接种疫苗，在诊断前60天以上接种疫苗），并在同一时间段内对COVID-19疫苗接种后1-60天内被诊断为异常子宫出血的患者进行了详细的图表审查。
结果：在每月79,000至85,000名女性卫生系统成员中，每100,000人天诊断异常子宫出血的发生率为8.97~19.19.在大流行前（2019年1月至2020年1月）和COVID-19疫苗后（2020年12月至2021年12月）期间，异常子宫出血诊断的发生率水平或趋势没有显着变化。通过疫苗接种状态对2,717例异常子宫出血病例的临床特征的比较表明，最近接种疫苗的患者中的异常出血与从未接种疫苗的患者或超过60天之前接种疫苗的患者中的异常出血相似或较不严重。根据疫苗接种状态诊断出异常子宫出血的患者的年龄和种族也存在显着差异：从未接种疫苗的患者最年轻，而60天以上接种疫苗的患者最年长;从未接种疫苗的患者中，黑人/非裔美国人的比例最高。在接种疫苗的患者中，亚洲患者的比例较高。从2020年12月至2021年10月13日诊断的114例确诊的疫苗接种后异常子宫出血病例的图表审查发现，报告的最常见症状是时间变化，持续时间,和出血量。大约三分之一的病例没有接受诊断检查；57％的病例在电子健康记录中没有记录出血的病因。在12%的案例中,患者提到或询问他们的出血与他们最近的COVID-19疫苗之间的可能联系。
结论：在我们超过79,000名育龄女性患者的人群中，COVID-19疫苗接种的可用性与药物治疗异常子宫出血发生率的变化无关。此外,在COVID-19疫苗上市后的2717例异常子宫出血患者中，接种疫苗与出血严重程度无关.
