背景:关于绝经前人群COVID-19疫苗接种后月经变化的文献基础越来越多。然而,对COVID-19疫苗接种后绝经后子宫出血的了解相对较少。
目的:研究COVID-19疫苗接种前后绝经后出血的诊断趋势,并描述COVID-19疫苗接种后新发绝经后出血的病例。
方法:对于PMB发病率计算,每月人口级别的队列由45岁及以上的西北KaiserPermanente女性成员组成。电子病历中被诊断为绝经后出血事件的患者被纳入每月分子中。既往有绝经后出血或异常子宫出血的成员,或由于其他健康状况而导致出血风险增加的人,被排除在每月计算之外。我们使用分段回归分析来估计2018年至2021年KaiserPermanente西北成员符合纳入标准的绝经后出血诊断发生率的变化。2021年按COVID-19疫苗接种状况分层。此外,我们确定了在2020年12月14日至2021年8月14日期间接种了≥1次COVID-19疫苗的所有成员,这些成员在疫苗接种后60天内有绝经后出血事件诊断.COVID-19疫苗接种,诊断程序,和推测的出血病因通过图表回顾和描述进行评估。对所有没有明确出血病因的病例进行时间扫描统计。
结果:在每月75,530至82,693人的人群中,在COVID-19疫苗引入前后,绝经后出血的发生率没有统计学上的显着差异(p=0.59)。104人在COVID-19疫苗接种后60天内被诊断出绝经后出血事件;76%的病例(79/104)在图表审查后被确认为疫苗接种后绝经后出血。从疫苗接种到出血发作的中位时间为21天(范围:2-54天)。在56例绝经后出血病例中,有提供者归因于病因,出血的常见原因是子宫或宫颈病变(50%[28/56]),激素替代疗法(13%[7/56]),和增生性子宫内膜(13%[7/56])。在无明确病因的23例中,疫苗接种后绝经后出血发作没有统计学显著的聚集性.
结论:在这个综合卫生系统中,COVID-19疫苗的引入与绝经后出血事件诊断的增加无关.在接受COVID-19疫苗接种后60天内很少诊断出绝经后出血。
There is a growing literature base regarding menstrual changes following COVID-19 vaccination among premenopausal people. However, relatively little is known about uterine bleeding in postmenopausal people following COVID-19 vaccination.
This study aimed to examine trends in incident postmenopausal bleeding diagnoses over time before and after COVID-19 vaccine introduction, and to describe cases of new-onset postmenopausal bleeding after COVID-19 vaccination.
For postmenopausal bleeding incidence calculations, monthly population-level cohorts consisted of female Kaiser Permanente Northwest members aged ≥45 years. Those diagnosed with incident postmenopausal bleeding in the electronic medical record were included in monthly numerators. Members with preexisting postmenopausal bleeding or abnormal uterine bleeding, or who were at increased risk of bleeding due to other health conditions, were excluded from monthly calculations. We used segmented regression analysis to estimate changes in the incidence of postmenopausal bleeding diagnoses from 2018 through 2021 in Kaiser Permanente Northwest members meeting the inclusion criteria, stratified by COVID-19 vaccination status in 2021. In addition, we identified all members with ≥1 COVID-19 vaccination between December 14, 2020 and August 14, 2021, who had an incident postmenopausal bleeding diagnosis within 60 days of vaccination. COVID-19 vaccination, diagnostic procedures, and presumed bleeding etiology were assessed through chart review and described. A temporal scan statistic was run on all cases without clear bleeding etiology.
In a population of 75,530 to 82,693 individuals per month, there was no statistically significant difference in the rate of incident postmenopausal bleeding diagnoses before and after COVID-19 vaccine introduction (P=.59). A total of 104 individuals had incident postmenopausal bleeding diagnosed within 60 days following COVID-19 vaccination; 76% of cases (79/104) were confirmed as postvaccination postmenopausal bleeding after chart review. Median time from vaccination to bleeding onset was 21 days (range: 2-54 days). Among the 56 postmenopausal bleeding cases with a provider-attributed etiology, the common causes of bleeding were uterine or cervical lesions (50% [28/56]), hormone replacement therapy (13% [7/56]), and proliferative endometrium (13% [7/56]). Among the 23 cases without a clear etiology, there was no statistically significant clustering of postmenopausal bleeding onset following vaccination.
Within this integrated health system, introduction of COVID-19 vaccines was not associated with an increase in incident postmenopausal bleeding diagnoses. Diagnosis of postmenopausal bleeding in the 60 days following receipt of a COVID-19 vaccination was rare.