Complementary Chinese Herbal Medicine Treatment is Associated with a Reduction of Surgical Rate in Patients with Dysfunctional Uterine Bleeding: A Propensity-Score Matched Cohort Study

Abstract

Background: Many patients with dysfunctional uterine bleeding (DUB) seek traditional medicine consultations. This study intended to investigate the association of complementary Chinese herbal medicine (CHM) with the surgery rate in patients with DUB in Taiwan.

Methods: We enrolled 43,027 patients with newly diagnosed DUB (ICD-9-CM codes 626.8) from the National Health Insurance Research Database in Taiwan during the period of 1997 to 2010. Among them, 38,324 were CHM users, and 4703 did not receive CHM treatment. After performing a 1:1 propensity-score match based on patients' age (per 5 years), comorbidities, conventional drugs, childbirth status, duration from the diagnosis year of DUB and index year, there were an equal number (n=4642) of patients in the CHM cohort and non-CHM cohort. The outcome measurement was the comparison of incidences of surgical events, including hysterectomy and endometrial ablation, in the two cohorts before the end of 2013.

Results: CHM users had a lower incidence of surgery than non-CHM users (adjusted HR 0.27, 95% CI: 0.22-0.33). The cumulative incidence of surgery was significantly lower in the CHM cohort during the follow-up period (Log rank test, p < 0.001). A total of 146 patients in the CHM cohort (4.99 per 1000 person-years) and 485 patients in the non-CHM cohort (20.19 per 1000 person-years) received surgery (adjusted HR 0.27, 95% CI: 0.22-0.33). CHM also reduced the risk of surgery in DUB patients with or without comorbidities. Regardless of childbirth status or whether patients took NSAIDs, tranexamic acid or progesterone, fewer patients in the CHM cohort underwent surgery than in the non-CHM cohort. The most commonly prescribed single herb and formula were Yi-Mu-Cao (Herba Leonuri) and Jia-Wei-Xiao-Yao-San, respectively.

Conclusion: The real-world data revealed that CHM is associated with a reduced surgery rate in DUB patients. This information may be provided for further clinical investigations and policy-making.

Keywords: Chinese herbal medicine; National Health Insurance Research Database; complementary and alternative medicine; dysfunctional uterine bleeding; hysterectomy; surgery.

Figure 1

Flow recruitment chart. We identified the newly diagnosed dysfunctional uterine bleeding (DUB) patients from 1997 to 2000 from one million randomly selected subjects of the Longitudinal Health Insurance Database 2000 (LHID 2000) in Taiwan. After excluding patients according to the excluding criteria, we included 43,027 patients and separated them into CHM users (n=38,324) and non-CHM users (n=4,703) according to whether they received TCM treatment or not after the initial diagnosis of DUB. After performing 1:1 propensity score matching, there were 4642 patients in the CHM and non-CHM cohorts.

Figure 2

Cumulative incidence of surgery between the CHM cohort and non-CHM cohort. The cumulative incidence of surgeries related to dysfunctional uterine bleeding (DUB) in the CHM cohort (dashed line) is significantly lower than in the non-CHM cohort (solid line) (Log rank test, p<0.001).