Clinical Utility of the PBAC Score in Quantifying Treatment Response to Hysteroscopy in Women with Abnormal Uterine Bleeding

Clinical Utility of the PBAC Score in Quantifying Treatment Response to Hysteroscopy in Women with Abnormal Uterine Bleeding | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Utility of the PBAC Score in Quantifying Treatment Response to Hysteroscopy in Women with Abnormal Uterine Bleeding Ömer Faruk Öz, Can Dinç, Burhan Öğüt, Selen Doğan, Murat Özekinci, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7248269/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the clinical utility of the Pictorial Blood Loss Assessment Chart (PBAC) as a quantitative tool for measuring treatment response in patients undergoing hysteroscopy for abnormal uterine bleeding (AUB), and to examine its correlation with changes in hemoglobin levels, endometrial thickness, and patient satisfaction. Materials and Methods This retrospective study included 327 patients who underwent hysteroscopy for AUB between January 2021 and January 2024 at a tertiary care center. Patients with incomplete records, inadequate follow-up, technically unsuccessful procedures, concurrent major surgeries, or endometrial cancer were excluded. Postoperative menstrual bleeding was assessed using the Pictorial Blood Loss Assessment Chart (PBAC). Data were analyzed using SPSS version 26, and p < 0.05 was considered statistically significant. Results Of the 327 patients included in the study, 91.1% had a baseline PBAC score ≥ 100, which significantly decreased following hysteroscopy (mean reduction: 393 points; p < .001). Postoperative Hemoglobin (Hb) levels and Endometrial Thickness (ET) also improved significantly in patients with high initial bleeding scores. Overall complication rate was low (6.4%), and 87% of patients reported satisfaction and willingness to recommend the procedure. McNemar analysis confirmed a significant shift from high to low bleeding severity postoperatively (p < .001). Conclusions Hysteroscopy demonstrated clinical efficacy in the management of abnormal uterine bleeding. Assessment using the PBAC score provided a feasible and informative method for quantifying treatment response, supporting its role as a valuable tool in the objective evaluation of bleeding outcomes. Obstetrics & Gynecology Hematology Critical Care & Emergency Medicine hysteroscopy abnormal uterine bleeding minimally invasive surgery Introduction Abnormal uterine bleeding (AUB) is a common gynecological condition encountered in clinical practice, affecting women across various age groups and significantly impairing quality of life, daily functioning, and sexual well-being [ 1 , 2 ]. The differential diagnosis of AUB includes a wide range of structural and non-structural etiologies, as outlined in the PALM-COEIN classification system [ 1 ]. Establishing an accurate diagnosis and providing effective management requires an interdisciplinary approach involving clinical evaluation, imaging techniques, and, in selected cases, direct visualization of the uterine cavity. Hysteroscopy has become the gold-standard diagnostic and therapeutic tool for evaluating intrauterine pathologies, particularly in women with abnormal uterine or postmenopausal bleeding (PMB)[ 2 ]. In addition to enabling direct visualization, it allows precise therapeutic procedures such as polypectomy, myomectomy, and endometrial ablation, all performed in a minimally invasive manner. Studies conducted in both outpatient and office-based settings have confirmed the safety, effectiveness, and high satisfaction rates associated with operative hysteroscopy [ 3 ]. While the diagnostic accuracy of hysteroscopy is well-established, limited evidence exists regarding its actual impact on menstrual symptomatology, particularly when evaluated using objective measurement tools[ 4 ]. One such tool is the Pictorial Blood Loss Assessment Chart (PBAC), a validated semi-quantitative method commonly employed in research settings to assess the severity of menstrual bleeding in women with AUB[ 5 ]. Originally developed by Higham et al.[ 6 ], the PBAC assigns scores based on the degree of soiling on sanitary products, with a threshold of ≥ 100 correlating with objectively measured menstrual blood loss exceeding 80 mL, which is a widely accepted criterion for menorrhagia. The tool has demonstrated high sensitivity and specificity in identifying heavy menstrual bleeding[ 6 ], yet it remains underutilized in routine assessments of hysteroscopic outcomes. Subsequent studies have confirmed the diagnostic validity of PBAC in various populations. For instance, Ko et al. reported excellent discriminatory capacity between normal and excessive menstrual bleeding among Asian women, with an area under the curve (AUC) of 0.96, reinforcing its reliability as a screening instrument in clinical practice[ 7 ]. Moreover, PBAC has also proven useful for monitoring treatment outcomes in AUB. A reduction of more than 100 points in PBAC scores following intervention has been associated with clinically meaningful improvements in Hb levels and patient-reported quality of life[ 7 ]. In this study, we aimed to explore how hysteroscopy impacts clinical outcomes in women undergoing the procedure for abnormal uterine or postmenopausal bleeding. We placed particular emphasis on changes in bleeding severity using the PBAC, as well as shifts in hemoglobin levels and overall patient satisfaction. Materials and Methods This retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, with the approval of the institutional ethics committee (Approval No: TBAEK-243). The study population consisted of patients who underwent hysteroscopic procedures between January 2021 and December 2024 for either AUB or PMB. A total of 419 medical records were screened. Patients were excluded if they had incomplete clinical or questionnaire data, underwent concomitant gynecologic surgeries, were on hormonal treatments that could influence menstrual bleeding patterns, had systemic bleeding disorders, experienced pregnancy-related bleeding, were diagnosed with uterine or endometrial malignancy, or presented with major uterine anomalies. After the application of these exclusion criteria, 327 patients were included in the final analysis. The dataset was compiled using the institutional electronic medical record system and supplemented by direct patient contact. To ensure adequate follow-up, patients were invited for an in-person visit at the third postoperative month. For those who had not returned by that time, telephone calls were made to facilitate follow-up assessment. During these visits, patients who consented to participate completed both preoperative and postoperative PBAC questionnaires. The following clinical variables were retrieved and analyzed for each patient: age, hospital admission date, duration of hospitalization (in hours), body mass index (BMI), baseline and postoperative Hb levels, preoperative and postoperative endometrial thickness (ET) (in millimeters), PBAC scores, operative time (in minutes), fluid deficit (in milliliters), patient satisfaction, and willingness to recommend the procedure to others. In addition, we recorded the type of hysteroscopic intervention (e.g., endomyometrial resection, polypectomy, myomectomy), occurrence of intraoperative complications, whether cervical ripening agents were used preoperatively, and the need for subsequent surgical interventions postoperatively. Histopathological findings from resected specimens were reviewed, and relevant statistical assessments were conducted to evaluate correlations between clinical, surgical, and symptomatic outcomes. Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). The distribution of continuous variables was assessed using skewness and kurtosis coefficients, as well as visual (histograms, box plots) and analytical methods, including the Kolmogorov–Smirnov test. For variables that did not meet the assumption of normality, descriptive statistics were presented as median, interquartile range (Q1–Q3), and minimum–maximum values. Categorical variables were summarized using frequencies and percentages. For comparisons between groups: The Mann–Whitney U test was used to compare continuous variables between two independent groups. The Wilcoxon signed-rank test was applied to assess differences between two paired measurements (e.g., preoperative vs. postoperative scores). For relationships between two categorical variables, the Pearson Chi-Square test was used when the expected cell count was adequate (i.e., < 20% of cells with expected count < 5); otherwise, Fisher’s Exact test was applied. For paired categorical variables, the McNemar test was utilized. Spearman’s rank correlation coefficient (r) was calculated to evaluate associations between two continuous variables, with the strength and direction of the correlation interpreted accordingly. A p-value < .05 was considered statistically significant for all analyses. Where applicable, effect sizes (e.g., r or φ) were calculated to indicate the magnitude of observed differences or associations. Results Among the individuals included in the study, 91.1% (n = 298) had an initial PBAC score of ≥ 100, while only 8.9% (n = 29) had a score < 100. At follow-up, 79.2% (n = 259) demonstrated PBAC scores < 100, whereas 20.8% (n = 68) had scores ≥ 100. Cervical ripening agents were used in 51.1% of the patients (n = 167). Among the procedures performed, endomyometrial resection (EMR) accounted for 71.9% (n = 235), followed by polypectomy (19.0%, n = 62) and myomectomy (12.5%, n = 41). The most frequently observed pathological diagnosis was normal endometrium (36.7%), followed by endometrial polyps (21.4%) and leiomyomas (15.0%). Less common findings included adenomyosis (10.4%), simple hyperplasia (8.9%), complex hyperplasia (4.0%), endometrial intraepithelial neoplasia (EIN, 3.4%), and endometritis (0.3%). When the distribution of complications was examined, no complications were reported in 93.6% of cases (n = 306). The most common complication was bleeding (3.1%), followed by uterine perforation (1.8%) and endometritis (1.5%), resulting in an overall complication rate of 6.4% (n = 21). During the postoperative course, 24.2% of patients required an additional surgical intervention. The most frequently performed procedure was hysterectomy, conducted via either an abdominal or laparoscopic approach (22.3%), while hysteroscopic polypectomy and myomectomy were performed less often. In terms of patient-reported outcomes, 45.3% of participants reported being “satisfied” with the procedure, while 42.2% indicated they were “very satisfied.” The dissatisfaction rate remained low at 12.5%. Furthermore, 88.1% of patients stated that they would recommend the surgical procedure to a friend or someone with similar complaints. (Table 1). Table 1 Descriptive Statistics for Categorical Variables n (%) Initial PBAC Score =100 298 (91.1) Follow-up PBAC Score =100 68 (20.8) Cervical Ripening Not used 160 (48.9) Used 167 (51.1) Pathology Normal endometrium 120 (36.7) Endometrial polyp 70 (21.4) Leiomyoma 49 (15) Adenomyosis 34 (10.4) Complex hyperplasia 13 (4) Endometritis 1 (0.3) Simple hyperplasia 29 (8.9) EIN 11 (3.4) Patient Satisfaction Not at all satisfied 9 (2.8) Not satisfied 32 (9.8) Satisfied 148 (45.3) Very satisfied 138 (42.2) Willingness to Recommend the Procedure No 39 (11.9) Yes 288 (88.1) Procedure: EMR Performed 235 (71.9) Procedure: Polypectomy Performed 62 (19) Procedure: Myomectomy Performed 41 (12.5) Complications No Complication 306 (93.6) Endometritis 5 (1.5) Uterine rupture 6 (1.8) Hemorrhage 10 (3.1) Overall Complication Rate No 306 (93.6) Yes 21 (6.4) Postoperative Surgery No Surgery Performed 248 (75.8) Laparoscopy (Total Hysterectomy) 34 (10.4) Laparotomy (Total Hysterectomy) 39 (11.9) Hysteroscopic Polypectomy 5 (1.5) Hysteroscopic Myomectomy 1 (0.3) Postoperative Surgery (Overall) No 248 (75.8) Yes 79 (24.2) The study population consisted of 327 individuals, with a mean age of 43.49 years (SD = 7.48), ranging from 23 to 67 years. The median age was 43 years, and the age distribution demonstrated a symmetrical pattern. The mean BMI of participants was 27.57 kg/m² (SD = 4.18), within the overweight range, with values ranging from 17 to 42 kg/m². The average hospital stay was 20.45 hours (SD = 27.03), ranging from 8 to 240 hours, with a median of 8 hours. Given the high standard deviation relative to the mean and the substantially lower median, the distribution was notably right-skewed, indicating that a small subset of patients experienced prolonged hospitalization. The mean baseline hemoglobin (Hb) level was 10.18 g/dL (SD = 1.51), increasing to 10.97 g/dL (SD = 1.34) after treatment. Endometrial thickness (ET) showed a mean decrease from 13.62 mm (SD = 5.56) preoperatively to 7.14 mm (SD = 2.62) postoperatively, corresponding to a reduction of 6.48 mm. The average duration of the surgical procedure was 23.31 minutes (SD = 5.26), with a range of 10 to 43 minutes. The mean fluid deficit was 634.8 cc (SD = 328.01), with a wide distribution ranging from 150 to 1850 cc. The mean initial PBAC score was 477.17 (SD = 539.38), with a median value of 330, while the mean follow-up PBAC score was 83.65 (SD = 163.89), and the median was 45. The change in PBAC scores (ΔPBAC) demonstrated an average reduction of 393.52 points. The high standard deviation in both preoperative and postoperative scores, particularly in the baseline values, along with the relatively lower median, suggests a positively skewed distribution. This finding indicates that a subset of patients experienced disproportionately heavy menstrual bleeding prior to intervention (see Table 2). Statistically significant differences were observed between patients with an initial PBAC score < 100 and those with a score ≥ 100 in several numerical variables, as shown in Table 3. No significant differences were found in age, total hospital stay, follow-up Hb level, duration of surgery, fluid deficit, or change in endometrial thickness (p > .05). Patients in the < 100 group had a significantly higher mean BMI (29.75 ± 5.80) compared to those in the ≥ 100 group (27.35 ± 3.94), p = .022. Baseline hemoglobin levels were also higher in the < 100 group (11.02 ± 2.00 g/dL) than in the ≥ 100 group (10.10 ± 1.44 g/dL), p = .033. In terms of bleeding outcomes, the < 100 group had lower follow-up PBAC scores (32.76 ± 25.61 vs. 88.60 ± 170.71, p < .001), whereas the ≥ 100 group demonstrated greater reductions in PBAC scores (429.34 ± 554.38 vs. 25.45 ± 23.54, p < .001) and greater increases in hemoglobin (0.83 ± 0.99 vs. 0.38 ± 1.07, p = .034). Table 4 presents the comparison of numerical variables between patients with a follow-up PBAC Score of less than 100 and those with a score equal to or greater than 100. According to the Table 4, participants with a follow-up PBAC Score ≥ 100 had significantly higher initial PBAC scores (M = 628.81, SD = 567.53) compared to those with a follow-up PBAC Score < 100 (M = 437.35, SD = 525.66), p < .001. Moreover, as expected, follow-up PBAC Scores differed significantly between the groups. The mean follow-up PBAC Score was 255.72 (SD = 301.12) in the PBAC ≥ 100 group and 38.47 (SD = 23.23) in the PBAC < 100 group, p < .001. No statistically significant differences were observed between the groups in terms of age, total hospital stay, BMI, baseline Hb, follow-up Hb, ET (both preoperative and postoperative), duration of surgery, fluid deficit, Hb change, PBAC score change, or ET change (p > .05). As shown in Table 5, a statistically significant difference was observed in satisfaction levels between the PBAC groups (χ²(2) = 8.12, p = .016). While 31.0% of individuals in the PBAC < 100 group reported being "not satisfied or very dissatisfied," this proportion was only 10.7% in the PBAC ≥ 100 group. This finding suggests that individuals who initially experienced higher levels of bleeding reported greater satisfaction following treatment. The likelihood of recommending the procedure to others also differed significantly between the groups (Fisher’s Exact Test, p = .013). While 72.4% of individuals in the PBAC < 100 group stated that they would recommend the procedure, this proportion increased to 89.6% in the PBAC ≥ 100 group. A statistically significant difference in complication rates was also observed between the groups (Fisher’s Exact Test, p = .029). Complications were reported in 17.2% of individuals in the PBAC < 100 group, compared to 5.4% in the PBAC ≥ 100 group. When complication types were examined, a particularly significant difference was noted in the frequency of uterine rupture (Fisher’s Exact Test, p = .011). The incidence of uterine rupture was 10.3% in the PBAC < 100 group, whereas it was only 1% in the PBAC ≥ 100 group. In contrast, no statistically significant differences were observed between the groups in other categorical variables, including the use of cervical ripening, pathology results, types of surgical procedures (EMR, polypectomy, myomectomy), postoperative surgical requirements, and endometrial status (p > .05). Table 5 Comparison of Categorical Variables Between Individuals with Initial PBAC Scores < 100 and ≥ 100 Initial PBAC score =100 n % n % Test p Cervical Ripening Not used 16 55,2% 144 48,3% 0,496 0,481 a Used 13 44,8% 154 51,7% Pathology Normal Endometrium 11 37,9% 109 36,6% 7,24 0,385 b Endometrial Polyp 10 34,5% 60 20,1% Leiomyoma 4 13,8% 45 15,1% Adenomyosis 0 0,0% 34 11,4% Complex Hyperplasia 1 3,4% 12 4,0% Endometritis 0 0,0% 1 0,3% Simple Hyperplasia 2 6,9% 27 9,1% EIN 1 3,4% 10 3,4% Satisfaction (Four-Level Scale) Not at all satisfied 2 6,9%c 7 2,3% c 8,973 0,021 b Not satisfied 7 24,1%c 25 8,4% d Satisfied 10 34,5%c 138 46,3% c Very satisfied 10 34,5%c 128 43,0% c Satisfaction (Three-Level Grouping) Not satisfied - Not at all satisfied 9 31,0%c 32 10,7% d 8,121 0,016 a Satisfied 10 34,5%c 138 46,3% c Very satisfied 10 34,5%c 128 43,0% c Willingness to Recommend the Procedure No 8 27,6% 31 10,4% 0,013 b Yes 21 72,4% 267 89,6% Procedure: EMR Not performed 7 24,1% 85 28,5% 0,251 0,616 a Performed 22 75,9% 213 71,5% Procedure: Polypectomy Not performed 24 82,8% 241 80,9% 0,061 0,805 a Performed 5 17,2% 57 19,1% Procedure: Myomectomy Not performed 26 89,7% 260 87,2% 0,999 b Performed 3 10,3% 38 12,8% Complications No Complication 24 82,8%c 282 94,6% d 10,014 0,011 b Endometritis 1 3,4%c 4 1,3% c Uterine rupture 3 10,3%c 3 1%d Hemorrhage 1 3,4%c 9 3%c Overall Complication Rate No 24 82,8% 282 94,6% 0,029 b Yes 5 17,2% 16 5,4% Postoperative Surgery No Surgery Performed 25 86,2% 223 74,8% 3,051 0,547 b Laparoscopy (Total Hysterectomy) 3 10,3% 31 10,4% Laparotomy (Total Hysterectomy) 1 3,4% 38 12,8% Hysteroscopic Polypectomy 0 0,0% 5 1,7% Hysteroscopic Myomectomy 0 0,0% 1 0,3% Postoperative Surgery (Overall) No 25 86,2% 223 74,8% 1,866 0,172 a Yes 4 13,8% 75 25,2% a: Pearson’s Chi-Square Test b: Fisher’s Exact Test c, d: Note. Values with different superscript letters (e.g., c vs. d) within the same column indicate statistically significant differences (p < .05). When patients were grouped according to their follow-up PBAC scores ( .05). For example, the use of cervical ripening agents was similar in both groups—performed in 52.1% of the PBAC < 100 group and 47.1% of the PBAC ≥ 100 group (χ²(1) = 0.55, p = .457). Pathological evaluations also showed a comparable distribution, with “normal endometrium” being the most common finding in both groups (36.3% vs. 38.2%, p = .995). Patient experiences appeared to be equally favorable across both groups. The proportion of participants who reported feeling “dissatisfied” or “very dissatisfied” with the procedure was relatively low and statistically similar—12.0% in the PBAC < 100 group compared to 14.7% in the PBAC ≥ 100 group (χ²(2) = 0.37, p = .832). Likewise, the vast majority of participants indicated that they would recommend the procedure to others, with similar rates between the two groups (88.4% vs. 86.8%, χ²(1) = 0.14, p = .708). Surgical approaches did not differ meaningfully between groups. Common procedures such as endometrial mechanical evacuation (EME), polypectomy, and myomectomy were applied at comparable frequencies. For instance, polypectomy was performed in 17.4% of patients in the PBAC < 100 group and 25.0% in the PBAC ≥ 100 group (p = .153). Complication rates were generally low and evenly distributed (93.8% vs. 92.6% without complications; p = .691), and no notable differences were observed in the types of complications reported. Similarly, the need for any further surgical intervention after the procedure was uncommon and did not vary significantly between groups. Most patients did not require additional surgery, with rates of 75.3% in the PBAC < 100 group and 77.9% in the PBAC ≥ 100 group (p = .850). Table 6 Comparison of Categorical Variables Between Individuals with Follow-up PBAC Scores < 100 and ≥ 100 Follow-up PBAC Score =100 n % n % Test p Cervical Ripening Not used 124 47.9% 36 52.9% 0.553 0.457 a Used 135 52.1% 32 47.1% Pathology Normal Endometrium 94 36.3% 26 38.2% 1.329 0.995 b Endometrial Polyp 55 21.2% 15 22.1% Leiomyoma 39 15.1% 10 14.7% Adenomyosis 27 10.4% 7 10.3% Complex Hyperplasia 11 4.2% 2 2.9% Endometritis 1 0.4% 0 0.0% Simple Hyperplasia 24 9.3% 5 7.4% EIN 8 3.1% 3 4.4% Satisfaction (Four-Level Scale) Not at all satisfied 7 2.7% 2 2.9% 0.646 0.897 a Not satisfied 24 9.3% 8 11.8% Satisfied 118 45.6% 30 44.1% Very satisfied 110 42.5% 28 41.2% Satisfaction (Three-Level Grouping) Not satisfied - Not at all satisfied 31 12.0% 10 14.7% 0.368 0.832 a Satisfied 118 45.6% 30 44.1% Very satisfied 110 42.5% 28 41.2% Willingness to Recommend the Procedure No 30 11.6% 9 13.2% 0.14 0.708 a Yes 229 88.4% 59 86.8% Procedure: EMR Not performed 69 26.6% 23 33.8% 1.374 0.241 a Performed 190 73.4% 45 66.2% Procedure: Polypectomy Not performed 214 82.6% 51 75.0% 2.038 0.153 a Performed 45 17.4% 17 25.0% Procedure: Myomectomy Not performed 227 87.6% 59 86.8% 0.038 0.845 a Performed 32 12.4% 9 13.2% Complications No Complication 243 93.8% 63 92.6% 1.557 0.691 b Endometritis 3 1.2% 2 2.9% Uterine rupture 5 1.9% 1 1.5% Hemorrhage 8 3.1% 2 2.9% Overall Complication Rate No 243 93.8% 63 92.6% 0.781 b Yes 16 6.2% 5 7.4% Postoperative Surgery No Surgery Performed 195 75.3% 53 77.9% 1.453 0.850 b L/S Total Hysterectomy 29 11.2% 5 7.4% L/T Total Hysterectomy 30 11.6% 9 13.2% Hysteroscopic Polypectomy 4 1.5% 1 1.5% Hysteroscopic Myomectomy 1 0.4% 0 0.0% Postoperative Surgery (Overall) No 195 75.3% 53 77.9% 0.207 0.649 a Yes 64 24.7% 15 22.1% a Pearson’s Chi-Square Test, b Fisher’s Exact Test, L/S = Laparoscopic surgery; L/T = Laparotomy Among participants with an initial PBAC score ≥ 100, 77.2% (n = 230) experienced a reduction to < 100 at follow-up, while only 22.8% (n = 68) remained at ≥ 100. In contrast, none of the individuals who initially had a PBAC score < 100 (n = 0) showed an increase to ≥ 100 at follow-up. This asymmetrical distribution was statistically significant according to the McNemar test (p < .001), indicating a marked reduction in bleeding severity in a substantial proportion of patients after treatment. At baseline, 91.1% of participants had PBAC scores ≥ 100. By the time of follow-up, only 20.8% remained in this high bleeding category. This reflects a significant overall shift in bleeding status, as confirmed by the McNemar test (p < .001; Table 7). Table 8 presents the changes in hemoglobin (Hb) levels and ET before and after treatment in patients stratified by their initial PBAC scores (< 100 vs. ≥100). In the group with an initial PBAC score < 100, the mean baseline Hb level was 11.02 g/dL (SD = 2.00), increasing slightly to 11.40 g/dL (SD = 1.76) at follow-up. This change was not statistically significant (p = .061). In contrast, patients with an initial PBAC score ≥ 100 exhibited a significant improvement in Hb levels, with mean values rising from 10.10 g/dL (SD = 1.44) at baseline to 10.92 g/dL (SD = 1.28) after treatment (p < .001). These findings suggest that patients with more severe baseline menstrual bleeding experienced greater hematologic benefit following intervention. Regarding ET, both groups showed a significant reduction from baseline to follow-up. Among individuals with an initial PBAC score < 100, the mean ET decreased from 12.55 mm (SD = 5.47) to 6.29 mm (SD = 2.40) (p < .001). Similarly, in the ≥ 100 group, the mean ET declined from 13.72 mm (SD = 5.56) to 7.22 mm (SD = 2.63), also reflecting a statistically significant reduction (p < .001). Table 8 Change in Hb and ET(mm) in Groups with Initial PBAC Score < 100 and ≥ 100 Initial PBAC Score =100 (n = 298) Mean ± SD Median (Q1–Q3) Mean ± SD Median (Q1–Q3) Baseline Hb (g/dL) 11.0 ± 2.0 10.4 (9.5–13.2) 10.1 ± 1.4 10.2 (9.2–11.1) Follow-up Hb (g/dL) 11.4 ± 1.8 11.4 (10–12.7) 10.9 ± 1.3 10.8 (10.4–11.8) Wilcoxon Z-value -1.872 -11.815 p 0.061 < 0.001 Pre-op ET (mm) 12.6 ± 5.5 12 (8–16) 13.7 ± 5.6 13.2 (9–18) Post-op ET (mm) 6.3 ± 2.4 6 (5–8) 7.2 ± 2.6 7 (5–8) Wilcoxon Z-value -4.182 -13.751 p < 0.001 < 0.001 Assessed using the Wilcoxon Signed-Rank Test. Table 9 summarizes the changes in hemoglobin (Hb) levels and endometrial thickness (ET) according to follow-up PBAC score groups (< 100 vs. ≥100). Among individuals with a follow-up PBAC score < 100, a statistically significant increase in Hb levels was observed following treatment (Z = -10.72, p < .001). The mean baseline Hb level in this group was 10.17 g/dL (SD = 1.52), rising to 10.98 g/dL (SD = 1.37) post-treatment. A similar pattern was seen in the PBAC ≥ 100 group, where the mean Hb increased from 10.22 g/dL (SD = 1.49) to 10.93 g/dL (SD = 1.18), also reflecting a significant improvement (Z = -5.06, p < .001). These findings indicate a reduction in menstrual blood loss in both groups, regardless of final bleeding severity. Regarding endometrial thickness, both groups demonstrated significant decreases following treatment. In the PBAC < 100 group, the mean endometrial thickness decreased from 13.64 mm (SD = 5.58) pre-treatment to 7.04 mm (SD = 2.41) post-treatment (Z = -5.06, p < .001). In the PBAC ≥ 100 group, a similar reduction was noted, with mean values declining from 13.54 mm (SD = 5.50) to 7.49 mm (SD = 3.32) (Z = -5.99, p < .001). Table 9 Pre- and Post-treatment Changes in Hb and ET According to Follow-up PBAC Score Groups (< 100 vs. ≥100) Follow-up PBAC Score =100 (n = 68) Mean ± SD Median (Q1–Q3) Mean ± SD Median (Q1–Q3) Baseline Hb (g/dL) 10.2 ± 1.5 10.2 (9.2–11.2) 10.2 ± 1.5 10.2 (9.4–11.2) Post-op Hb (g/dL) 11.0 ± 1.4 10.8 (10.2–12.3) 10.9 ± 1.2 10.9 (10.4–11.7) Wilcoxon Z-value -10.72 -5.06 p < 0.001 < 0.001 Pre-op ET (mm) 13.6 ± 5.5 13 (9–18) 13.5 ± 5.5 13.5 (9–17) Post-op ET (mm) 6.3 ± 2.4 7 (5–8) 7.5 ± 3.3 7 (5–8.5) Wilcoxon Z-value -5.06 -5.99 p < 0.001 < 0.001 Assessed using the Wilcoxon Signed-Rank Test. As shown in Table 10, there was a weak but statistically significant positive correlation between initial and follow-up PBAC scores (r = .278, p < .001), suggesting that those who began with heavier bleeding tended to maintain relatively higher scores, even after treatment. Initial PBAC scores were also moderately and negatively correlated with both baseline and follow-up hemoglobin (Hb) levels (r = –.284 and r = –.233, respectively; both p < .001), reflecting the expected association between heavier menstrual bleeding and lower Hb concentrations. Notably, a very strong negative correlation emerged between the initial PBAC score and the overall reduction in PBAC following treatment (r = –.894, p < .001). This indicates that patients with more severe bleeding at baseline experienced the greatest improvements. A weaker, yet statistically significant, positive correlation was also found between initial PBAC scores and changes in Hb levels (r = .157, p = .004), meaning that Hb levels tended to rise more in those who had greater blood loss to begin with. In contrast, no meaningful correlations were observed between follow-up PBAC scores and any of the continuous variables analyzed (p > .05), suggesting that post-treatment bleeding levels were not closely tied to other clinical or demographic indicators. Table 10 Correlation Between Initial and Follow-up PBAC Scores and Continuous Variables Initial PBAC Score Follow-up PBAC Score Initial PBAC Score r 1 .278** p . < 0.001 n 327 327 Baseline Hb (g/dL) r − .284** 0.024 p < 0.001 0.666 n 327 327 Follow-up Hb (g/dL) r − .233** -0.045 p < 0.001 0.42 n 327 327 Change in Hb (g/dL) r .157** -0.077 p 0.004 0.166 n 327 327 Change in PBAC Score r − .894** 0.023 p < 0.001 0.683 n 327 327 Spearman’s Rank Correlation Test Discussion The present study aimed to evaluate the clinical effectiveness of hysteroscopic interventions in abnormal uterine bleeding by analyzing changes in postoperative PBAC scores. In doing so, we also sought to investigate the usefulness of the PBAC scoring system as a practical and objective method for assessing treatment response based on improvements in menstrual bleeding, hemoglobin levels, and endometrial thickness. In particular, we observed a statistically significant reduction in PBAC scores following surgery, with 79.2% of patients who were initially classified as having heavy menstrual bleeding (PBAC ≥ 100) falling below this threshold following surgery. This finding is in line with current literature on the efficacy of hysteroscopic surgery in treating AUB by removing focal intrauterine pathology such as polyps and submucous myomas[ 8 , 9 ]. Notably, the reduction in PBAC scores showed a modest yet significant correlation with increases in hemoglobin levels, highlighting the clinical relevance of decreased menstrual blood loss. This observation aligns with the findings of studies that similarly reported that improvements in bleeding severity are often accompanied by meaningful gains in hemoglobin, underscoring the physiological benefit of effective treatment[ 10 ]. A significant reduction in menstrual blood loss following hysteroscopic surgery was one of the most prominent observations of this study. The median PBAC score decreased significantly from 340 to 45 in the group with PBAC ≥ 100, and nearly 80% of the patients moved into the PBAC < 100 group after surgery. This corroborates existing evidence that removal of endometrial polyps or submucous fibroids through hysteroscopy significantly decreases menstrual quantity and improves quality of life. For example, van Dongen et al. noted a decrease in median PBAC score from 288 to 155 at six months after hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding[ 11 ]. Likewise, Acharya et al. noted a dramatic fall in PBAC to about 65 one year after hysteroscopic treatment, with more than 80% of the patients recording complete or partial resolution of symptoms (p < 0.001)[ 12 ]. A systematic review by Magnay et al. provides additional support for the clinical usefulness of PBAC as a valid and objective outcome measure for assessing treatment effect in patients with heavy menstrual bleeding[ 5 ]. This decrease in bleeding was also accompanied by a highly significant increase in hemoglobin levels, particularly in the PBAC ≥ 100 group, with the mean hemoglobin level rising from 10.1 to 10.9 g/dL. The statistically significant correlation (r = .157, p = .004) between the decrease of PBAC and the increase in hemoglobin further indicates the physiological effect of the intervention. In contrast, the PBAC < 100 group had only a minimal and statistically nonsignificant hemoglobin increase, which is consistent with the lower initial bleeding burden in these women. These findings offer evidence to substantiate the role of hysteroscopy not only in symptomatic relief but also in anemia reduction in the context of chronic heavy menstrual bleeding. Another important clinical finding in our study was the marked reduction in ET following hysteroscopic surgery. In both PBAC < 100 and PBAC ≥ 100 groups, median ET values decreased significantly post-surgery, in keeping with effective removal of intracavitary disease. Although there is limited literature reporting postoperative ET change in a longitudinal fashion, it is understood that removal of lesions via hysteroscopy is a factor in normalization of endometrial anatomy and symptom relief in AUB patients. In our cohort, the concordance between ET reduction, decreased PBAC scores, and hemoglobin level improvement provides validity for ET as a surrogate marker of procedural effectiveness in this context. In addition to objective clinical endpoints, patient-reported outcomes in this study also serve to further highlight the therapeutic value of hysteroscopy. Most patients (87.5%) were satisfied with the procedure and 88.1% would undergo it again and recommend it to others. These observations highlight the real-world acceptability and perceived value of hysteroscopy from the patient's viewpoint. In addition, the need for re-intervention was very low, with only 1.2% requiring a second surgical intervention during the follow-up interval. This very low retreatment rate provides support for the longevity of symptom control with hysteroscopy and is consistent with previous reports of high patient satisfaction and long-term efficacy with hysteroscopic polypectomy or myomectomy. Collectively, these findings affirm that hysteroscopy is both a clinically and experientially effective modality for the treatment of abnormal uterine bleeding. With regard to safety, our study had a favorable complication profile. The overall postoperative complication rate was low (6.4%), and the most frequent issue was bleeding (3.1%). There were no other complications of uterine perforation or infection, which speaks to the minimally invasive and generally well-tolerated nature of hysteroscopy. Notably, the complication rate was significantly higher in the PBAC < 100 group (p = .029), which may reflect inherent anatomical differences, type of procedure, or selection bias, with more complicated or less overtly symptomatic cases possibly being approached with greater caution in the PBAC ≥ 100 group. However, overall incidence of adverse events remained well within the acceptable bounds reported in the literature, where hysteroscopic procedures are typically associated with complication rates of less than 5–7% in experienced hands[ 13 , 14 ]. These findings support hysteroscopy as an effective and safe treatment modality for the management of AUB, with low risk of morbidity when carried out in appropriately selected patients. In our subgroup analysis, BMI and baseline Hb levels were the only demographic variables with statistically significant group difference between the PBAC < 100 and PBAC ≥ 100 groups. Those with higher PBAC scores had significantly lower BMI and lower initial hemoglobin levels. These findings are perhaps reflective of the physiological consequences of chronic or excessive menstrual bleeding, namely iron-deficiency anemia and nutritional depletion, more likely to affect those with fewer body reserves. Higher BMI, however, has been associated in some studies with heaviness of menstrual bleeding due to estrogen excess and chronic endometrial stimulation, although the association is multifactorial and complex[ 15 , 16 ]. In our population, however, the reverse trend was observed. This would suggest that bleeding severity is more closely linked to local uterine pathology than the systemic hormonal milieu. These demographic associations underscore the need for individualized assessment in AUB, with consideration of both systemic and intrauterine factors implicated in bleeding burden. There are a number of important strengths in this study. First, the sample size of 327 patients is quite large, allowing subgroup analysis with adequate statistical power. Second, both objective (PBAC score, hemoglobin, ET) and patient-reported outcomes (satisfaction, willingness to recommend) were measured, providing a comprehensive view of the clinical impact of hysteroscopic treatment. Last, the use of a standardized and validated bleeding assessment tool (PBAC) enhances the reproducibility and comparability of our findings. Furthermore, the fact that histopathological findings were included in the analysis provides the opportunity for correlation between severity of bleeding and particular intrauterine pathologies, providing richness to the interpretation of clinical outcomes. Some limitations should be acknowledged, however. The retrospective design obviously limits the ability for establishing causal relationships and may be prone to selection bias. Additionally, while PBAC is a very widely used measure, it is nonetheless a semi-quantitative evaluation and may be prone to reporting variability. Follow-up was limited to short- to mid-term outcomes; longer-term outcomes for recurrence and re-intervention rates were not available. Hormonal status data were also not available, which would have provided further insight into bleeding mechanisms. Despite these limitations, the study provides significant evidence in support of the clinical and patient-centered benefits of hysteroscopy in AUB management. Conclusion In conclusion, this work illustrates that hysteroscopic therapy is efficacious in lowering menstrual blood loss and enhancing clinical outcomes in women with abnormal uterine bleeding. PBAC changes after treatment were shown to mirror significant changes in hemoglobin levels, endometrial thickness, and satisfaction in patients. These observations affirm the usefulness of PBAC as a tool that is both convenient and meaningful in assessing response to treatment in a clinical setup, and strengthen the therapeutic role of hysteroscopy in managing intrauterine pathologies that cause abnormal bleeding. Declarations Acknowledgments The authors have no acknowledgments to declare. Funding / Conflict of Interest The authors received no financial support for the research, authorship, and/or publication of this article. The authors declare no conflicts of interest. References Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. American family physician. 2019;99(7):435-43. Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, et al. Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics. 2022;12(5):1176. Wortman M, Daggett A, Ball C. Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases. Journal of minimally invasive gynecology. 2013;20(1):56-63. Warner P, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray G. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. bmj. 2001;323(7303):24-8. Magnay JL, O’Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC women's health. 2020;20:1-15. Higham JM, O'brien P, Shaw R. Assessment of menstrual blood loss using a pictorial chart. BJOG: An International Journal of Obstetrics & Gynaecology. 1990;97(8):734-9. Ko JK, Lao TT, Cheung VY. Pictorial Blood Loss Assessment Chart for evaluating heavy menstrual bleeding in Asian women. 香港醫學雜誌. 2021. Deutsch A, Sasaki KJ, Cholkeri-Singh A. Resectoscopic surgery for polyps and myomas: a review of the literature. Journal of Minimally Invasive Gynecology. 2017;24(7):1104-10. Giampaolino P, Della Corte L, Di Filippo C, Mercorio A, Vitale SG, Bifulco G. Office hysteroscopy in the management of women with postmenopausal bleeding. Climacteric. 2020;23(4):369-75. de Souza SS, Camargos AF, Ferreira MCF, de Assis Nunes Pereira F, de Rezende CP, Araújo CAA, et al. Hemoglobin levels predict quality of life in women with heavy menstrual bleeding. Archives of gynecology and obstetrics. 2010;281(5):895-900. Van Dongen H, Janssen C, Smeets M, Emanuel M, Jansen F. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(10):1387-90. Acharya N, Mishra P, Mohammad S, Karnik M, Muneeba S, Gemnani R, et al. Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update. Cureus. 2023;15(10). Jansen FW, Vredevoogd CB, Van Ulzen K, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstetrics & Gynecology. 2000;96(2):266-70. Wright KN, Hamilton K, Kosturakis A. An Overview of Office Hysteroscopy. Current Obstetrics and Gynecology Reports. 2024;13(2):88-96. Mena GP, Mielke GI, Brown WJ. Prospective associations between physical activity and BMI with irregular periods and heavy menstrual bleeding in a large cohort of Australian women. Human Reproduction. 2021;36(6):1481-91. Fielder S, Nickkho-Amiry M, Seif MW. Obesity and menstrual disorders. Best Practice & Research Clinical Obstetrics & Gynaecology. 2023;89:102343. Table 3, 4, 7 Table 3, 4, 7 are available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Table347.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7248269","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492911987,"identity":"a362c4b3-4b04-44a8-94e1-68460ccfd7e0","order_by":0,"name":"Ömer Faruk Öz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIie3PoQrCQBjA8R0DLUPrVvQVbgiaxAcxDeFM1xdULs3iA1wY+gpalgw3Ds9yaFVWtNhtEwyewyTMzSZ4f/g+OPh+4QxDp/vFWLYbaipqfDWmScqQ1ovIJwHfEBA8HwWklvDN8rqGzQ5F3vk2H/frU0VSP8olzg6hI71ANzwgDp1oiykHBMxkkkugtNqJxe6A2sPAdiOBiSImCArIncFeRrxQ4EUpYjDoURsJOyYjvCwijqyg44zBAbUuA5cIhleKxJ/+UpOmOKQMdmkVued0NMHzPY9PqZ9P3uPZZqXvVZNvjnU6ne5PegBSMGCakAZJhQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-5716-7210","institution":"Akdeniz University","correspondingAuthor":true,"prefix":"","firstName":"Ömer","middleName":"Faruk","lastName":"Öz","suffix":""},{"id":492911988,"identity":"730631c1-1560-43fb-aee9-f5ee5201f450","order_by":1,"name":"Can Dinç","email":"","orcid":"https://orcid.org/0000-0002-0634-9276","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Can","middleName":"","lastName":"Dinç","suffix":""},{"id":492911989,"identity":"08bbe85e-0804-4fad-82d3-a98e377e7a61","order_by":2,"name":"Burhan Öğüt","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Burhan","middleName":"","lastName":"Öğüt","suffix":""},{"id":492911990,"identity":"7118bd0f-bca9-4b18-9b3a-4b59b5cf983d","order_by":3,"name":"Selen Doğan","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Selen","middleName":"","lastName":"Doğan","suffix":""},{"id":492911991,"identity":"9b366518-7eaf-434e-afcf-df0d12e16b9e","order_by":4,"name":"Murat Özekinci","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Özekinci","suffix":""},{"id":492911992,"identity":"656cde32-4e4b-4450-a85b-dc66a7217a40","order_by":5,"name":"İnanç Mendilcioğlu","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"İnanç","middleName":"","lastName":"Mendilcioğlu","suffix":""}],"badges":[],"createdAt":"2025-07-30 04:13:42","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7248269/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7248269/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88101515,"identity":"6188fd3f-45ce-4621-83e9-f67ac4ff66de","added_by":"auto","created_at":"2025-08-01 11:31:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1193710,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7248269/v1/c4d91c58-afb5-4bb3-aa31-bd1845e1be49.pdf"},{"id":88099282,"identity":"000f9711-90f7-4902-9818-fc780e14e14f","added_by":"auto","created_at":"2025-08-01 11:15:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28113,"visible":true,"origin":"","legend":"","description":"","filename":"Table347.docx","url":"https://assets-eu.researchsquare.com/files/rs-7248269/v1/0875c6e3bdfbef2b51cea379.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eClinical Utility of the PBAC Score in Quantifying Treatment Response to Hysteroscopy in Women with Abnormal Uterine Bleeding\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAbnormal uterine bleeding (AUB) is a common gynecological condition encountered in clinical practice, affecting women across various age groups and significantly impairing quality of life, daily functioning, and sexual well-being [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The differential diagnosis of AUB includes a wide range of structural and non-structural etiologies, as outlined in the PALM-COEIN classification system [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Establishing an accurate diagnosis and providing effective management requires an interdisciplinary approach involving clinical evaluation, imaging techniques, and, in selected cases, direct visualization of the uterine cavity.\u003c/p\u003e\u003cp\u003eHysteroscopy has become the gold-standard diagnostic and therapeutic tool for evaluating intrauterine pathologies, particularly in women with abnormal uterine or postmenopausal bleeding (PMB)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition to enabling direct visualization, it allows precise therapeutic procedures such as polypectomy, myomectomy, and endometrial ablation, all performed in a minimally invasive manner. Studies conducted in both outpatient and office-based settings have confirmed the safety, effectiveness, and high satisfaction rates associated with operative hysteroscopy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile the diagnostic accuracy of hysteroscopy is well-established, limited evidence exists regarding its actual impact on menstrual symptomatology, particularly when evaluated using objective measurement tools[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. One such tool is the Pictorial Blood Loss Assessment Chart (PBAC), a validated semi-quantitative method commonly employed in research settings to assess the severity of menstrual bleeding in women with AUB[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Originally developed by Higham et al.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the PBAC assigns scores based on the degree of soiling on sanitary products, with a threshold of \u0026ge;\u0026thinsp;100 correlating with objectively measured menstrual blood loss exceeding 80 mL, which is a widely accepted criterion for menorrhagia. The tool has demonstrated high sensitivity and specificity in identifying heavy menstrual bleeding[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], yet it remains underutilized in routine assessments of hysteroscopic outcomes.\u003c/p\u003e\u003cp\u003eSubsequent studies have confirmed the diagnostic validity of PBAC in various populations. For instance, Ko et al. reported excellent discriminatory capacity between normal and excessive menstrual bleeding among Asian women, with an area under the curve (AUC) of 0.96, reinforcing its reliability as a screening instrument in clinical practice[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Moreover, PBAC has also proven useful for monitoring treatment outcomes in AUB. A reduction of more than 100 points in PBAC scores following intervention has been associated with clinically meaningful improvements in Hb levels and patient-reported quality of life[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we aimed to explore how hysteroscopy impacts clinical outcomes in women undergoing the procedure for abnormal uterine or postmenopausal bleeding. We placed particular emphasis on changes in bleeding severity using the PBAC, as well as shifts in hemoglobin levels and overall patient satisfaction.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, with the approval of the institutional ethics committee (Approval No: TBAEK-243). The study population consisted of patients who underwent hysteroscopic procedures between January 2021 and December 2024 for either AUB or PMB. A total of 419 medical records were screened.\u003c/p\u003e\u003cp\u003ePatients were excluded if they had incomplete clinical or questionnaire data, underwent concomitant gynecologic surgeries, were on hormonal treatments that could influence menstrual bleeding patterns, had systemic bleeding disorders, experienced pregnancy-related bleeding, were diagnosed with uterine or endometrial malignancy, or presented with major uterine anomalies. After the application of these exclusion criteria, 327 patients were included in the final analysis.\u003c/p\u003e\u003cp\u003eThe dataset was compiled using the institutional electronic medical record system and supplemented by direct patient contact. To ensure adequate follow-up, patients were invited for an in-person visit at the third postoperative month. For those who had not returned by that time, telephone calls were made to facilitate follow-up assessment. During these visits, patients who consented to participate completed both preoperative and postoperative PBAC questionnaires.\u003c/p\u003e\u003cp\u003eThe following clinical variables were retrieved and analyzed for each patient: age, hospital admission date, duration of hospitalization (in hours), body mass index (BMI), baseline and postoperative Hb levels, preoperative and postoperative endometrial thickness (ET) (in millimeters), PBAC scores, operative time (in minutes), fluid deficit (in milliliters), patient satisfaction, and willingness to recommend the procedure to others.\u003c/p\u003e\u003cp\u003eIn addition, we recorded the type of hysteroscopic intervention (e.g., endomyometrial resection, polypectomy, myomectomy), occurrence of intraoperative complications, whether cervical ripening agents were used preoperatively, and the need for subsequent surgical interventions postoperatively. Histopathological findings from resected specimens were reviewed, and relevant statistical assessments were conducted to evaluate correlations between clinical, surgical, and symptomatic outcomes.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). The distribution of continuous variables was assessed using skewness and kurtosis coefficients, as well as visual (histograms, box plots) and analytical methods, including the Kolmogorov\u0026ndash;Smirnov test.\u003c/p\u003e\u003cp\u003eFor variables that did not meet the assumption of normality, descriptive statistics were presented as median, interquartile range (Q1\u0026ndash;Q3), and minimum\u0026ndash;maximum values. Categorical variables were summarized using frequencies and percentages.\u003c/p\u003e\u003cp\u003eFor comparisons between groups: The Mann\u0026ndash;Whitney U test was used to compare continuous variables between two independent groups. The Wilcoxon signed-rank test was applied to assess differences between two paired measurements (e.g., preoperative vs. postoperative scores). For relationships between two categorical variables, the Pearson Chi-Square test was used when the expected cell count was adequate (i.e., \u0026lt;\u0026thinsp;20% of cells with expected count\u0026thinsp;\u0026lt;\u0026thinsp;5); otherwise, Fisher\u0026rsquo;s Exact test was applied. For paired categorical variables, the McNemar test was utilized. Spearman\u0026rsquo;s rank correlation coefficient (r) was calculated to evaluate associations between two continuous variables, with the strength and direction of the correlation interpreted accordingly.\u003c/p\u003e\u003cp\u003eA p-value\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered statistically significant for all analyses. Where applicable, effect sizes (e.g., r or φ) were calculated to indicate the magnitude of observed differences or associations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the individuals included in the study, 91.1% (n\u0026thinsp;=\u0026thinsp;298) had an initial PBAC score of \u0026ge;\u0026thinsp;100, while only 8.9% (n\u0026thinsp;=\u0026thinsp;29) had a score\u0026thinsp;\u0026lt;\u0026thinsp;100. At follow-up, 79.2% (n\u0026thinsp;=\u0026thinsp;259) demonstrated PBAC scores\u0026thinsp;\u0026lt;\u0026thinsp;100, whereas 20.8% (n\u0026thinsp;=\u0026thinsp;68) had scores\u0026thinsp;\u0026ge;\u0026thinsp;100. Cervical ripening agents were used in 51.1% of the patients (n\u0026thinsp;=\u0026thinsp;167). Among the procedures performed, endomyometrial resection (EMR) accounted for 71.9% (n\u0026thinsp;=\u0026thinsp;235), followed by polypectomy (19.0%, n\u0026thinsp;=\u0026thinsp;62) and myomectomy (12.5%, n\u0026thinsp;=\u0026thinsp;41).\u003c/p\u003e\n\u003cp\u003eThe most frequently observed pathological diagnosis was normal endometrium (36.7%), followed by endometrial polyps (21.4%) and leiomyomas (15.0%). Less common findings included adenomyosis (10.4%), simple hyperplasia (8.9%), complex hyperplasia (4.0%), endometrial intraepithelial neoplasia (EIN, 3.4%), and endometritis (0.3%).\u003c/p\u003e\n\u003cp\u003eWhen the distribution of complications was examined, no complications were reported in 93.6% of cases (n\u0026thinsp;=\u0026thinsp;306). The most common complication was bleeding (3.1%), followed by uterine perforation (1.8%) and endometritis (1.5%), resulting in an overall complication rate of 6.4% (n\u0026thinsp;=\u0026thinsp;21). During the postoperative course, 24.2% of patients required an additional surgical intervention. The most frequently performed procedure was hysterectomy, conducted via either an abdominal or laparoscopic approach (22.3%), while hysteroscopic polypectomy and myomectomy were performed less often.\u003c/p\u003e\n\u003cp\u003eIn terms of patient-reported outcomes, 45.3% of participants reported being \u0026ldquo;satisfied\u0026rdquo; with the procedure, while 42.2% indicated they were \u0026ldquo;very satisfied.\u0026rdquo; The dissatisfaction rate remained low at 12.5%. Furthermore, 88.1% of patients stated that they would recommend the surgical procedure to a friend or someone with similar complaints. (Table\u0026nbsp;1).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDescriptive Statistics for Categorical Variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eInitial PBAC Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e298 (91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFollow-up PBAC Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e259 (79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;=100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCervical Ripening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167 (51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal endometrium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial polyp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeiomyoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplex hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSimple hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePatient Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot at all satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWillingness to Recommend the Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e288 (88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProcedure: EMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235 (71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProcedure: Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProcedure: Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e306 (93.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOverall Complication Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e306 (93.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePostoperative Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Surgery Performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e248 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparoscopy (Total Hysterectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparotomy (Total Hysterectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePostoperative Surgery (Overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e248 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe study population consisted of 327 individuals, with a mean age of 43.49 years (SD\u0026thinsp;=\u0026thinsp;7.48), ranging from 23 to 67 years. The median age was 43 years, and the age distribution demonstrated a symmetrical pattern. The mean BMI of participants was 27.57 kg/m\u0026sup2; (SD\u0026thinsp;=\u0026thinsp;4.18), within the overweight range, with values ranging from 17 to 42 kg/m\u0026sup2;. The average hospital stay was 20.45 hours (SD\u0026thinsp;=\u0026thinsp;27.03), ranging from 8 to 240 hours, with a median of 8 hours. Given the high standard deviation relative to the mean and the substantially lower median, the distribution was notably right-skewed, indicating that a small subset of patients experienced prolonged hospitalization.\u003c/p\u003e\n\u003cp\u003eThe mean baseline hemoglobin (Hb) level was 10.18 g/dL (SD\u0026thinsp;=\u0026thinsp;1.51), increasing to 10.97 g/dL (SD\u0026thinsp;=\u0026thinsp;1.34) after treatment. Endometrial thickness (ET) showed a mean decrease from 13.62 mm (SD\u0026thinsp;=\u0026thinsp;5.56) preoperatively to 7.14 mm (SD\u0026thinsp;=\u0026thinsp;2.62) postoperatively, corresponding to a reduction of 6.48 mm. The average duration of the surgical procedure was 23.31 minutes (SD\u0026thinsp;=\u0026thinsp;5.26), with a range of 10 to 43 minutes. The mean fluid deficit was 634.8 cc (SD\u0026thinsp;=\u0026thinsp;328.01), with a wide distribution ranging from 150 to 1850 cc.\u003c/p\u003e\n\u003cp\u003eThe mean initial PBAC score was 477.17 (SD\u0026thinsp;=\u0026thinsp;539.38), with a median value of 330, while the mean follow-up PBAC score was 83.65 (SD\u0026thinsp;=\u0026thinsp;163.89), and the median was 45. The change in PBAC scores (\u0026Delta;PBAC) demonstrated an average reduction of 393.52 points. The high standard deviation in both preoperative and postoperative scores, particularly in the baseline values, along with the relatively lower median, suggests a positively skewed distribution. This finding indicates that a subset of patients experienced disproportionately heavy menstrual bleeding prior to intervention (see Table\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cdiv\u003eStatistically significant differences were observed between patients with an initial PBAC score\u0026thinsp;\u0026lt;\u0026thinsp;100 and those with a score\u0026thinsp;\u0026ge;\u0026thinsp;100 in several numerical variables, as shown in Table 3. No significant differences were found in age, total hospital stay, follow-up Hb level, duration of surgery, fluid deficit, or change in endometrial thickness (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/div\u003e\n\u003cp\u003ePatients in the \u0026lt;\u0026thinsp;100 group had a significantly higher mean BMI (29.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80) compared to those in the \u0026ge;\u0026thinsp;100 group (27.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94), p\u0026thinsp;=\u0026thinsp;.022. Baseline hemoglobin levels were also higher in the \u0026lt;\u0026thinsp;100 group (11.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00 g/dL) than in the \u0026ge;\u0026thinsp;100 group (10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 g/dL), p\u0026thinsp;=\u0026thinsp;.033. In terms of bleeding outcomes, the \u0026lt;\u0026thinsp;100 group had lower follow-up PBAC scores (32.76\u0026thinsp;\u0026plusmn;\u0026thinsp;25.61 vs. 88.60\u0026thinsp;\u0026plusmn;\u0026thinsp;170.71, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), whereas the \u0026ge;\u0026thinsp;100 group demonstrated greater reductions in PBAC scores (429.34\u0026thinsp;\u0026plusmn;\u0026thinsp;554.38 vs. 25.45\u0026thinsp;\u0026plusmn;\u0026thinsp;23.54, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and greater increases in hemoglobin (0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99 vs. 0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07, p\u0026thinsp;=\u0026thinsp;.034).\u003c/p\u003e\n\u003cdiv\u003eTable 4 presents the comparison of numerical variables between patients with a follow-up PBAC Score of less than 100 and those with a score equal to or greater than 100. According to the Table 4, participants with a follow-up PBAC Score\u0026thinsp;\u0026ge;\u0026thinsp;100 had significantly higher initial PBAC scores (M\u0026thinsp;=\u0026thinsp;628.81, SD\u0026thinsp;=\u0026thinsp;567.53) compared to those with a follow-up PBAC Score\u0026thinsp;\u0026lt;\u0026thinsp;100 (M\u0026thinsp;=\u0026thinsp;437.35, SD\u0026thinsp;=\u0026thinsp;525.66), p\u0026thinsp;\u0026lt;\u0026thinsp;.001. Moreover, as expected, follow-up PBAC Scores differed significantly between the groups. The mean follow-up PBAC Score was 255.72 (SD\u0026thinsp;=\u0026thinsp;301.12) in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group and 38.47 (SD\u0026thinsp;=\u0026thinsp;23.23) in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group, p\u0026thinsp;\u0026lt;\u0026thinsp;.001. No statistically significant differences were observed between the groups in terms of age, total hospital stay, BMI, baseline Hb, follow-up Hb, ET (both preoperative and postoperative), duration of surgery, fluid deficit, Hb change, PBAC score change, or ET change (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/div\u003e\n\u003cdiv\u003eAs shown in Table 5, a statistically significant difference was observed in satisfaction levels between the PBAC groups (\u0026chi;\u0026sup2;(2)\u0026thinsp;=\u0026thinsp;8.12, p\u0026thinsp;=\u0026thinsp;.016). While 31.0% of individuals in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group reported being \u0026quot;not satisfied or very dissatisfied,\u0026quot; this proportion was only 10.7% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group. This finding suggests that individuals who initially experienced higher levels of bleeding reported greater satisfaction following treatment. The likelihood of recommending the procedure to others also differed significantly between the groups (Fisher\u0026rsquo;s Exact Test, p\u0026thinsp;=\u0026thinsp;.013). While 72.4% of individuals in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group stated that they would recommend the procedure, this proportion increased to 89.6% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group. A statistically significant difference in complication rates was also observed between the groups (Fisher\u0026rsquo;s Exact Test, p\u0026thinsp;=\u0026thinsp;.029). Complications were reported in 17.2% of individuals in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group, compared to 5.4% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group. When complication types were examined, a particularly significant difference was noted in the frequency of uterine rupture (Fisher\u0026rsquo;s Exact Test, p\u0026thinsp;=\u0026thinsp;.011). The incidence of uterine rupture was 10.3% in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group, whereas it was only 1% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group. In contrast, no statistically significant differences were observed between the groups in other categorical variables, including the use of cervical ripening, pathology results, types of surgical procedures (EMR, polypectomy, myomectomy), postoperative surgical requirements, and endometrial status (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of Categorical Variables Between Individuals with Initial PBAC Scores\u0026thinsp;\u0026lt;\u0026thinsp;100 and \u0026ge;\u0026thinsp;100\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eInitial PBAC score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;=100\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCervical Ripening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,481\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51,7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal Endometrium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e7,24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e0,385\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial Polyp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeiomyoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplex Hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSimple Hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eSatisfaction (Four-Level Scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot at all satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,9%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,3%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e8,973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,021\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,1%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,4%\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,5%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46,3%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,5%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43,0%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eSatisfaction (Three-Level Grouping)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied - Not at all satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31,0%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,7%\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e8,121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,016\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,5%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46,3%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,5%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43,0%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWillingness to Recommend the Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,013\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: EMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,616\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,805\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89,7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,999\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82,8%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,6%\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e10,014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,011\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,3%\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,3%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1%d\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3%c\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOverall Complication Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,029\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePostoperative Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Surgery Performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e3,051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0,547\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparoscopy (Total Hysterectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparotomy (Total Hysterectomy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePostoperative Surgery (Overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e1,866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0,172\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003ea: Pearson\u0026rsquo;s Chi-Square Test b: Fisher\u0026rsquo;s Exact Test\u003c/p\u003e\n \u003cp\u003ec, d: Note. Values with different superscript letters (e.g., c vs. d) within the same column indicate statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen patients were grouped according to their follow-up PBAC scores (\u0026lt;\u0026thinsp;100 vs. \u0026ge;100), no statistically significant differences emerged in any of the categorical clinical variables examined (Table\u0026nbsp;6, p\u0026thinsp;\u0026gt;\u0026thinsp;.05). For example, the use of cervical ripening agents was similar in both groups\u0026mdash;performed in 52.1% of the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group and 47.1% of the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group (\u0026chi;\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;.457). Pathological evaluations also showed a comparable distribution, with \u0026ldquo;normal endometrium\u0026rdquo; being the most common finding in both groups (36.3% vs. 38.2%, p\u0026thinsp;=\u0026thinsp;.995).\u003c/p\u003e\n\u003cp\u003ePatient experiences appeared to be equally favorable across both groups. The proportion of participants who reported feeling \u0026ldquo;dissatisfied\u0026rdquo; or \u0026ldquo;very dissatisfied\u0026rdquo; with the procedure was relatively low and statistically similar\u0026mdash;12.0% in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group compared to 14.7% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group (\u0026chi;\u0026sup2;(2)\u0026thinsp;=\u0026thinsp;0.37, p\u0026thinsp;=\u0026thinsp;.832). Likewise, the vast majority of participants indicated that they would recommend the procedure to others, with similar rates between the two groups (88.4% vs. 86.8%, \u0026chi;\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;0.14, p\u0026thinsp;=\u0026thinsp;.708).\u003c/p\u003e\n\u003cp\u003eSurgical approaches did not differ meaningfully between groups. Common procedures such as endometrial mechanical evacuation (EME), polypectomy, and myomectomy were applied at comparable frequencies. For instance, polypectomy was performed in 17.4% of patients in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group and 25.0% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group (p\u0026thinsp;=\u0026thinsp;.153). Complication rates were generally low and evenly distributed (93.8% vs. 92.6% without complications; p\u0026thinsp;=\u0026thinsp;.691), and no notable differences were observed in the types of complications reported.\u003c/p\u003e\n\u003cp\u003eSimilarly, the need for any further surgical intervention after the procedure was uncommon and did not vary significantly between groups. Most patients did not require additional surgery, with rates of 75.3% in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group and 77.9% in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group (p\u0026thinsp;=\u0026thinsp;.850).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of Categorical Variables Between Individuals with Follow-up PBAC Scores\u0026thinsp;\u0026lt;\u0026thinsp;100 and \u0026ge;\u0026thinsp;100\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eFollow-up PBAC Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;=100\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCervical Ripening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.457\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUsed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal Endometrium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e1.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e0.995 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrial Polyp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeiomyoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplex Hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSimple Hyperplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eSatisfaction (Four-Level Scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot at all satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.897\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eSatisfaction (Three-Level Grouping)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied - Not at all satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.832\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWillingness to Recommend the Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.708\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: EMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e1.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.241\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.153\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProcedure: Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.845\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e1.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0.691\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine rupture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eOverall Complication Rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.781\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePostoperative Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Surgery Performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e1.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0.850\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL/S Total Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL/T Total Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Polypectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHysteroscopic Myomectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePostoperative Surgery (Overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.649\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003ea Pearson\u0026rsquo;s Chi-Square Test, b Fisher\u0026rsquo;s Exact Test, L/S\u0026thinsp;=\u0026thinsp;Laparoscopic surgery; L/T\u0026thinsp;=\u0026thinsp;Laparotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAmong participants with an initial PBAC score\u0026thinsp;\u0026ge;\u0026thinsp;100, 77.2% (n\u0026thinsp;=\u0026thinsp;230) experienced a reduction to \u0026lt;\u0026thinsp;100 at follow-up, while only 22.8% (n\u0026thinsp;=\u0026thinsp;68) remained at \u0026ge;\u0026thinsp;100. In contrast, none of the individuals who initially had a PBAC score\u0026thinsp;\u0026lt;\u0026thinsp;100 (n\u0026thinsp;=\u0026thinsp;0) showed an increase to \u0026ge;\u0026thinsp;100 at follow-up. This asymmetrical distribution was statistically significant according to the McNemar test (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), indicating a marked reduction in bleeding severity in a substantial proportion of patients after treatment.\u003c/p\u003e\n\u003cp\u003eAt baseline, 91.1% of participants had PBAC scores\u0026thinsp;\u0026ge;\u0026thinsp;100. By the time of follow-up, only 20.8% remained in this high bleeding category. This reflects a significant overall shift in bleeding status, as confirmed by the McNemar test (p\u0026thinsp;\u0026lt;\u0026thinsp;.001; Table 7).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;8 presents the changes in hemoglobin (Hb) levels and ET before and after treatment in patients stratified by their initial PBAC scores (\u0026lt;\u0026thinsp;100 vs. \u0026ge;100).\u003c/p\u003e\n\u003cp\u003eIn the group with an initial PBAC score\u0026thinsp;\u0026lt;\u0026thinsp;100, the mean baseline Hb level was 11.02 g/dL (SD\u0026thinsp;=\u0026thinsp;2.00), increasing slightly to 11.40 g/dL (SD\u0026thinsp;=\u0026thinsp;1.76) at follow-up. This change was not statistically significant (p\u0026thinsp;=\u0026thinsp;.061). In contrast, patients with an initial PBAC score\u0026thinsp;\u0026ge;\u0026thinsp;100 exhibited a significant improvement in Hb levels, with mean values rising from 10.10 g/dL (SD\u0026thinsp;=\u0026thinsp;1.44) at baseline to 10.92 g/dL (SD\u0026thinsp;=\u0026thinsp;1.28) after treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). These findings suggest that patients with more severe baseline menstrual bleeding experienced greater hematologic benefit following intervention.\u003c/p\u003e\n\u003cp\u003eRegarding ET, both groups showed a significant reduction from baseline to follow-up. Among individuals with an initial PBAC score\u0026thinsp;\u0026lt;\u0026thinsp;100, the mean ET decreased from 12.55 mm (SD\u0026thinsp;=\u0026thinsp;5.47) to 6.29 mm (SD\u0026thinsp;=\u0026thinsp;2.40) (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Similarly, in the \u0026ge;\u0026thinsp;100 group, the mean ET declined from 13.72 mm (SD\u0026thinsp;=\u0026thinsp;5.56) to 7.22 mm (SD\u0026thinsp;=\u0026thinsp;2.63), also reflecting a statistically significant reduction (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 8\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eChange in Hb and ET(mm) in Groups with Initial PBAC Score\u0026thinsp;\u0026lt;\u0026thinsp;100 and \u0026ge;\u0026thinsp;100\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eInitial PBAC Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100 (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;=100 (n\u0026thinsp;=\u0026thinsp;298)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Hb (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4 (9.5\u0026ndash;13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2 (9.2\u0026ndash;11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up Hb (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.4 (10\u0026ndash;12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.8 (10.4\u0026ndash;11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWilcoxon Z-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1.872\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-11.815\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.061\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-op ET (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (8\u0026ndash;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2 (9\u0026ndash;18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op ET (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (5\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWilcoxon Z-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-4.182\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-13.751\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessed using the Wilcoxon Signed-Rank Test.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;9 summarizes the changes in hemoglobin (Hb) levels and endometrial thickness (ET) according to follow-up PBAC score groups (\u0026lt;\u0026thinsp;100 vs. \u0026ge;100).\u003c/p\u003e\n\u003cp\u003eAmong individuals with a follow-up PBAC score\u0026thinsp;\u0026lt;\u0026thinsp;100, a statistically significant increase in Hb levels was observed following treatment (Z = -10.72, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The mean baseline Hb level in this group was 10.17 g/dL (SD\u0026thinsp;=\u0026thinsp;1.52), rising to 10.98 g/dL (SD\u0026thinsp;=\u0026thinsp;1.37) post-treatment. A similar pattern was seen in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group, where the mean Hb increased from 10.22 g/dL (SD\u0026thinsp;=\u0026thinsp;1.49) to 10.93 g/dL (SD\u0026thinsp;=\u0026thinsp;1.18), also reflecting a significant improvement (Z = -5.06, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). These findings indicate a reduction in menstrual blood loss in both groups, regardless of final bleeding severity.\u003c/p\u003e\n\u003cp\u003eRegarding endometrial thickness, both groups demonstrated significant decreases following treatment. In the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group, the mean endometrial thickness decreased from 13.64 mm (SD\u0026thinsp;=\u0026thinsp;5.58) pre-treatment to 7.04 mm (SD\u0026thinsp;=\u0026thinsp;2.41) post-treatment (Z = -5.06, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). In the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group, a similar reduction was noted, with mean values declining from 13.54 mm (SD\u0026thinsp;=\u0026thinsp;5.50) to 7.49 mm (SD\u0026thinsp;=\u0026thinsp;3.32) (Z = -5.99, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab9\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 9\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePre- and Post-treatment Changes in Hb and ET According to Follow-up PBAC Score Groups (\u0026lt;\u0026thinsp;100 vs. \u0026ge;100)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eFollow-up PBAC Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;100 (n\u0026thinsp;=\u0026thinsp;259)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026gt;=100 (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Hb (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2 (9.2\u0026ndash;11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2 (9.4\u0026ndash;11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op Hb (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.8 (10.2\u0026ndash;12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.9 (10.4\u0026ndash;11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWilcoxon Z-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-10.72\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-5.06\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-op ET (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (9\u0026ndash;18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5 (9\u0026ndash;17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op ET (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5\u0026ndash;8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWilcoxon Z-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-5.06\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e-5.99\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessed using the Wilcoxon Signed-Rank Test.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAs shown in Table 10, there was a weak but statistically significant positive correlation between initial and follow-up PBAC scores (r\u0026thinsp;=\u0026thinsp;.278, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), suggesting that those who began with heavier bleeding tended to maintain relatively higher scores, even after treatment. Initial PBAC scores were also moderately and negatively correlated with both baseline and follow-up hemoglobin (Hb) levels (r = \u0026ndash;.284 and r = \u0026ndash;.233, respectively; both p\u0026thinsp;\u0026lt;\u0026thinsp;.001), reflecting the expected association between heavier menstrual bleeding and lower Hb concentrations.\u003c/p\u003e\n\u003cp\u003eNotably, a very strong negative correlation emerged between the initial PBAC score and the overall reduction in PBAC following treatment (r = \u0026ndash;.894, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). This indicates that patients with more severe bleeding at baseline experienced the greatest improvements. A weaker, yet statistically significant, positive correlation was also found between initial PBAC scores and changes in Hb levels (r\u0026thinsp;=\u0026thinsp;.157, p\u0026thinsp;=\u0026thinsp;.004), meaning that Hb levels tended to rise more in those who had greater blood loss to begin with.\u003c/p\u003e\n\u003cp\u003eIn contrast, no meaningful correlations were observed between follow-up PBAC scores and any of the continuous variables analyzed (p\u0026thinsp;\u0026gt;\u0026thinsp;.05), suggesting that post-treatment bleeding levels were not closely tied to other clinical or demographic indicators.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab10\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 10\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCorrelation Between Initial and Follow-up PBAC Scores and Continuous Variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInitial PBAC Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFollow-up PBAC Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eInitial PBAC Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.278**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eBaseline Hb (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u0026thinsp;.284**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e327\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eFollow-up Hb (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u0026thinsp;.233**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eChange in Hb (g/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.157**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e327\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eChange in PBAC Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026minus;\u0026thinsp;.894**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e327\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSpearman\u0026rsquo;s Rank Correlation Test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to evaluate the clinical effectiveness of hysteroscopic interventions in abnormal uterine bleeding by analyzing changes in postoperative PBAC scores. In doing so, we also sought to investigate the usefulness of the PBAC scoring system as a practical and objective method for assessing treatment response based on improvements in menstrual bleeding, hemoglobin levels, and endometrial thickness.\u003c/p\u003e\u003cp\u003eIn particular, we observed a statistically significant reduction in PBAC scores following surgery, with 79.2% of patients who were initially classified as having heavy menstrual bleeding (PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100) falling below this threshold following surgery. This finding is in line with current literature on the efficacy of hysteroscopic surgery in treating AUB by removing focal intrauterine pathology such as polyps and submucous myomas[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Notably, the reduction in PBAC scores showed a modest yet significant correlation with increases in hemoglobin levels, highlighting the clinical relevance of decreased menstrual blood loss. This observation aligns with the findings of studies that similarly reported that improvements in bleeding severity are often accompanied by meaningful gains in hemoglobin, underscoring the physiological benefit of effective treatment[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA significant reduction in menstrual blood loss following hysteroscopic surgery was one of the most prominent observations of this study. The median PBAC score decreased significantly from 340 to 45 in the group with PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100, and nearly 80% of the patients moved into the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group after surgery. This corroborates existing evidence that removal of endometrial polyps or submucous fibroids through hysteroscopy significantly decreases menstrual quantity and improves quality of life. For example, van Dongen et al. noted a decrease in median PBAC score from 288 to 155 at six months after hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Likewise, Acharya et al. noted a dramatic fall in PBAC to about 65 one year after hysteroscopic treatment, with more than 80% of the patients recording complete or partial resolution of symptoms (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A systematic review by Magnay et al. provides additional support for the clinical usefulness of PBAC as a valid and objective outcome measure for assessing treatment effect in patients with heavy menstrual bleeding[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis decrease in bleeding was also accompanied by a highly significant increase in hemoglobin levels, particularly in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group, with the mean hemoglobin level rising from 10.1 to 10.9 g/dL. The statistically significant correlation (r\u0026thinsp;=\u0026thinsp;.157, p\u0026thinsp;=\u0026thinsp;.004) between the decrease of PBAC and the increase in hemoglobin further indicates the physiological effect of the intervention. In contrast, the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group had only a minimal and statistically nonsignificant hemoglobin increase, which is consistent with the lower initial bleeding burden in these women. These findings offer evidence to substantiate the role of hysteroscopy not only in symptomatic relief but also in anemia reduction in the context of chronic heavy menstrual bleeding.\u003c/p\u003e\u003cp\u003eAnother important clinical finding in our study was the marked reduction in ET following hysteroscopic surgery. In both PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 and PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 groups, median ET values decreased significantly post-surgery, in keeping with effective removal of intracavitary disease. Although there is limited literature reporting postoperative ET change in a longitudinal fashion, it is understood that removal of lesions via hysteroscopy is a factor in normalization of endometrial anatomy and symptom relief in AUB patients. In our cohort, the concordance between ET reduction, decreased PBAC scores, and hemoglobin level improvement provides validity for ET as a surrogate marker of procedural effectiveness in this context.\u003c/p\u003e\u003cp\u003eIn addition to objective clinical endpoints, patient-reported outcomes in this study also serve to further highlight the therapeutic value of hysteroscopy. Most patients (87.5%) were satisfied with the procedure and 88.1% would undergo it again and recommend it to others. These observations highlight the real-world acceptability and perceived value of hysteroscopy from the patient's viewpoint. In addition, the need for re-intervention was very low, with only 1.2% requiring a second surgical intervention during the follow-up interval. This very low retreatment rate provides support for the longevity of symptom control with hysteroscopy and is consistent with previous reports of high patient satisfaction and long-term efficacy with hysteroscopic polypectomy or myomectomy. Collectively, these findings affirm that hysteroscopy is both a clinically and experientially effective modality for the treatment of abnormal uterine bleeding.\u003c/p\u003e\u003cp\u003eWith regard to safety, our study had a favorable complication profile. The overall postoperative complication rate was low (6.4%), and the most frequent issue was bleeding (3.1%). There were no other complications of uterine perforation or infection, which speaks to the minimally invasive and generally well-tolerated nature of hysteroscopy. Notably, the complication rate was significantly higher in the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 group (p\u0026thinsp;=\u0026thinsp;.029), which may reflect inherent anatomical differences, type of procedure, or selection bias, with more complicated or less overtly symptomatic cases possibly being approached with greater caution in the PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 group. However, overall incidence of adverse events remained well within the acceptable bounds reported in the literature, where hysteroscopic procedures are typically associated with complication rates of less than 5\u0026ndash;7% in experienced hands[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings support hysteroscopy as an effective and safe treatment modality for the management of AUB, with low risk of morbidity when carried out in appropriately selected patients.\u003c/p\u003e\u003cp\u003eIn our subgroup analysis, BMI and baseline Hb levels were the only demographic variables with statistically significant group difference between the PBAC\u0026thinsp;\u0026lt;\u0026thinsp;100 and PBAC\u0026thinsp;\u0026ge;\u0026thinsp;100 groups. Those with higher PBAC scores had significantly lower BMI and lower initial hemoglobin levels. These findings are perhaps reflective of the physiological consequences of chronic or excessive menstrual bleeding, namely iron-deficiency anemia and nutritional depletion, more likely to affect those with fewer body reserves. Higher BMI, however, has been associated in some studies with heaviness of menstrual bleeding due to estrogen excess and chronic endometrial stimulation, although the association is multifactorial and complex[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our population, however, the reverse trend was observed. This would suggest that bleeding severity is more closely linked to local uterine pathology than the systemic hormonal milieu. These demographic associations underscore the need for individualized assessment in AUB, with consideration of both systemic and intrauterine factors implicated in bleeding burden.\u003c/p\u003e\u003cp\u003eThere are a number of important strengths in this study. First, the sample size of 327 patients is quite large, allowing subgroup analysis with adequate statistical power. Second, both objective (PBAC score, hemoglobin, ET) and patient-reported outcomes (satisfaction, willingness to recommend) were measured, providing a comprehensive view of the clinical impact of hysteroscopic treatment. Last, the use of a standardized and validated bleeding assessment tool (PBAC) enhances the reproducibility and comparability of our findings. Furthermore, the fact that histopathological findings were included in the analysis provides the opportunity for correlation between severity of bleeding and particular intrauterine pathologies, providing richness to the interpretation of clinical outcomes. Some limitations should be acknowledged, however.\u003c/p\u003e\u003cp\u003eThe retrospective design obviously limits the ability for establishing causal relationships and may be prone to selection bias. Additionally, while PBAC is a very widely used measure, it is nonetheless a semi-quantitative evaluation and may be prone to reporting variability. Follow-up was limited to short- to mid-term outcomes; longer-term outcomes for recurrence and re-intervention rates were not available. Hormonal status data were also not available, which would have provided further insight into bleeding mechanisms. Despite these limitations, the study provides significant evidence in support of the clinical and patient-centered benefits of hysteroscopy in AUB management.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this work illustrates that hysteroscopic therapy is efficacious in lowering menstrual blood loss and enhancing clinical outcomes in women with abnormal uterine bleeding. PBAC changes after treatment were shown to mirror significant changes in hemoglobin levels, endometrial thickness, and satisfaction in patients. These observations affirm the usefulness of PBAC as a tool that is both convenient and meaningful in assessing response to treatment in a clinical setup, and strengthen the therapeutic role of hysteroscopy in managing intrauterine pathologies that cause abnormal bleeding.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no acknowledgments to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding / Conflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article. The authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWouk N, Helton M. Abnormal uterine bleeding in premenopausal women. American family physician. 2019;99(7):435-43.\u003c/li\u003e\n\u003cli\u003eVitale SG, Watrowski R, Barra F, D\u0026rsquo;Alterio MN, Carugno J, Sathyapalan T, et al. Abnormal uterine bleeding in perimenopausal women: the role of hysteroscopy and its impact on quality of life and sexuality. Diagnostics. 2022;12(5):1176.\u003c/li\u003e\n\u003cli\u003eWortman M, Daggett A, Ball C. Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases. Journal of minimally invasive gynecology. 2013;20(1):56-63.\u003c/li\u003e\n\u003cli\u003eWarner P, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray G. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. bmj. 2001;323(7303):24-8.\u003c/li\u003e\n\u003cli\u003eMagnay JL, O\u0026rsquo;Brien S, Gerlinger C, Seitz C. Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC women\u0026apos;s health. 2020;20:1-15.\u003c/li\u003e\n\u003cli\u003eHigham JM, O\u0026apos;brien P, Shaw R. Assessment of menstrual blood loss using a pictorial chart. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 1990;97(8):734-9.\u003c/li\u003e\n\u003cli\u003eKo JK, Lao TT, Cheung VY. Pictorial Blood Loss Assessment Chart for evaluating heavy menstrual bleeding in Asian women. 香港醫學雜誌. 2021.\u003c/li\u003e\n\u003cli\u003eDeutsch A, Sasaki KJ, Cholkeri-Singh A. Resectoscopic surgery for polyps and myomas: a review of the literature. Journal of Minimally Invasive Gynecology. 2017;24(7):1104-10.\u003c/li\u003e\n\u003cli\u003eGiampaolino P, Della Corte L, Di Filippo C, Mercorio A, Vitale SG, Bifulco G. Office hysteroscopy in the management of women with postmenopausal bleeding. Climacteric. 2020;23(4):369-75.\u003c/li\u003e\n\u003cli\u003ede Souza SS, Camargos AF, Ferreira MCF, de Assis Nunes Pereira F, de Rezende CP, Ara\u0026uacute;jo CAA, et al. Hemoglobin levels predict quality of life in women with heavy menstrual bleeding. Archives of gynecology and obstetrics. 2010;281(5):895-900.\u003c/li\u003e\n\u003cli\u003eVan Dongen H, Janssen C, Smeets M, Emanuel M, Jansen F. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 2009;116(10):1387-90.\u003c/li\u003e\n\u003cli\u003eAcharya N, Mishra P, Mohammad S, Karnik M, Muneeba S, Gemnani R, et al. Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update. Cureus. 2023;15(10).\u003c/li\u003e\n\u003cli\u003eJansen FW, Vredevoogd CB, Van Ulzen K, Hermans J, Trimbos JB, Trimbos-Kemper TC. Complications of hysteroscopy: a prospective, multicenter study. Obstetrics \u0026amp; Gynecology. 2000;96(2):266-70.\u003c/li\u003e\n\u003cli\u003eWright KN, Hamilton K, Kosturakis A. An Overview of Office Hysteroscopy. Current Obstetrics and Gynecology Reports. 2024;13(2):88-96.\u003c/li\u003e\n\u003cli\u003eMena GP, Mielke GI, Brown WJ. Prospective associations between physical activity and BMI with irregular periods and heavy menstrual bleeding in a large cohort of Australian women. Human Reproduction. 2021;36(6):1481-91.\u003c/li\u003e\n\u003cli\u003eFielder S, Nickkho-Amiry M, Seif MW. Obesity and menstrual disorders. Best Practice \u0026amp; Research Clinical Obstetrics \u0026amp; Gynaecology. 2023;89:102343.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 3, 4, 7","content":"\u003cp\u003eTable 3, 4, 7 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Akdeniz University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hysteroscopy, abnormal uterine bleeding, minimally invasive surgery","lastPublishedDoi":"10.21203/rs.3.rs-7248269/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7248269/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate the clinical utility of the Pictorial Blood Loss Assessment Chart (PBAC) as a quantitative tool for measuring treatment response in patients undergoing hysteroscopy for abnormal uterine bleeding (AUB), and to examine its correlation with changes in hemoglobin levels, endometrial thickness, and patient satisfaction.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e\u003cp\u003e This retrospective study included 327 patients who underwent hysteroscopy for AUB between January 2021 and January 2024 at a tertiary care center. Patients with incomplete records, inadequate follow-up, technically unsuccessful procedures, concurrent major surgeries, or endometrial cancer were excluded. Postoperative menstrual bleeding was assessed using the Pictorial Blood Loss Assessment Chart (PBAC). Data were analyzed using SPSS version 26, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 327 patients included in the study, 91.1% had a baseline PBAC score\u0026thinsp;\u0026ge;\u0026thinsp;100, which significantly decreased following hysteroscopy (mean reduction: 393 points; p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Postoperative Hemoglobin (Hb) levels and Endometrial Thickness (ET) also improved significantly in patients with high initial bleeding scores. Overall complication rate was low (6.4%), and 87% of patients reported satisfaction and willingness to recommend the procedure. McNemar analysis confirmed a significant shift from high to low bleeding severity postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eHysteroscopy demonstrated clinical efficacy in the management of abnormal uterine bleeding. Assessment using the PBAC score provided a feasible and informative method for quantifying treatment response, supporting its role as a valuable tool in the objective evaluation of bleeding outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical Utility of the PBAC Score in Quantifying Treatment Response to Hysteroscopy in Women with Abnormal Uterine Bleeding","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 11:15:03","doi":"10.21203/rs.3.rs-7248269/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5d035a5d-264c-4f69-9982-971122985a02","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52341675,"name":"Obstetrics \u0026 Gynecology"},{"id":52341676,"name":"Hematology"},{"id":52341677,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2025-08-01T11:15:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-01 11:15:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7248269","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7248269","identity":"rs-7248269","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}