Efficacy and Safety Study for the Treatment of Dysfunctional Uterine Bleeding
- Conditions
- Metrorrhagia
- Interventions
- Registration Number
- NCT00307801
- Lead Sponsor
- Bayer
- Brief Summary
The purpose of this study is to determine whether the study drug is safe and effective in the treatment of dysfunctional uterine bleeding.
- Detailed Description
The study has previously been posted by Schering AG, Germany. Schering AG, Germany has been renamed to Bayer HealthCare AG, Germany. Bayer HealthCare AG, Germany is the sponsor of the trial.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 231
- Women 18 years or older
- And with a diagnosis of dysfunctional uterine bleeding without organic pathology
- And with at least one of the following symptoms: prolonged, frequent or excessive bleeding.
- The use of steroidal oral contraceptives, or any drug that could alter oral contraception metabolism will be prohibited during the study.
- Women with a history of endometrial ablation or dilatation and curettage within 2 months prior to study start will be excluded.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Estradiol valerate/Dienogest (Natazia, Qlaira, BAY86-5027) Estradiol valerate/Dienogest (Natazia, Qlaira, BAY86-5027) A blister consists of 28 tablets taken orally once a day for 28 days (one cycle): 2 days of 3 mg estradiol valerate (EV); 5 days of 2 mg EV + 2 mg dienogest (DNG); 17 days of 2 mg EV + 3 mg DNG; 2 days of 1 mg EV; 2 days of placebo. Placebo Placebo Matching placebo to be taken orally daily.
- Primary Outcome Measures
Name Time Method Proportion of Participants With no Dysfunctional Uterine Bleeding (DUB) Symptoms Efficacy phase was defined as a 90-day period under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 At least 6, up to 8 criteria to be met in complete response during 90-day period: no bleeding episodes(BE) \>7 days, no \>4 BE, no BE with blood loss (menstrual blood loss, MBL) ≥80 mL, no \>1 BE increase from baseline, no increase from baseline in individual patient's total number of bleeding days and total number of bleeding days not \>24 days. Additionally, for subjects included with prolonged bleeding: decrease between maximum duration during run-in and efficacy ≥2 days excessive bleeding: MBL associated with each episode decreased by ≥50% from average of qualifying episodes during run-in.
- Secondary Outcome Measures
Name Time Method Menstrual Blood Loss Volume for All Participants at Cycle 3 Cycle 3 = 28 days (one cycle) Menstrual blood loss volume as assessed by the alkaline hematin method after patients were on treatment for 3 cycles. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Change From Baseline in Ferritin Concentration at Treatment Day 196 Baseline (visit 5, day 1) and treatment day 196 Ferritin was measured before treatment and after 196 days under treatment. A positive value indicates an increase in ferritin from baseline at treatment day 196.
Proportion of Participants With Improvement in the Patient's Overall Assessment Scale at Treatment Day 196 From baseline (visit 5, day 1) up to treatment day 196 According to the patient´s global assessment scale "improved" was defined as being classified as 'very much improved', 'much improved', or 'improved' and "not improved" was defined as being classified as 'no change', 'worse', 'much worse', 'very much worse', or 'not assessed'. Patients assessed the overall improvement at day 196 compared with admission to the study condition.
Change From Baseline in Blood Loss Volume for All Participants to the Reference Period of 90 Days Under Treatment Baseline and reference period of 90 days under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 Menstrual blood loss volume as assessed by the alkaline hematin method for the 90 days before treatment (baseline) and for 90 days under treatment. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction. A negative value indicates a reduction in blood loss after treatment.
Proportion of Participants Cured From Prolonged Bleeding Efficacy phase was defined as a 90-day period under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 Prolonged bleeding: 2 or more bleeding episodes, each lasting 8 or more days. Cure from prolonged bleeding: no bleeding episodes lasting more than 7 days and the decrease between maximum duration during run-in and maximum duration during the efficacy phase was at least 2 days.
Proportion of Participants With Improvement in the Investigator's Global Assessment Scale at Treatment Day 84 From baseline (visit 5, day 1) up to treatment day 84 According to the investigator's global assessment scale "improved" was defined as being classified as 'very much improved', 'much improved', or 'improved' and "not improved" was defined as being classified as 'no change', 'worse', 'much worse', 'very much worse', or 'not assessed'. Central laboratory data, physical examination, e-diary data, and patient interview were used as sources for the assessment at day 84 compared with admission to study data.
Proportion of Participants With Improvement in the Patient's Overall Assessment Scale at Treatment Day 84 From baseline (visit 5, day 1) up to treatment day 84 According to the patient's global assessment scale "improved" was defined as being classified as 'very much improved', 'much improved', or 'improved' and "not improved" was defined as being classified as 'no change', 'worse', 'much worse', 'very much worse', or 'not assessed'. Patients assessed the overall improvement at day 84 compared with admission to the study condition.
Proportion of Participants Cured From Excessive Bleeding Efficacy phase was defined as a 90-day period under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 Excessive bleeding:\>=2 bleeding episodes each with blood loss volume (MBL) of \>=80 mL in 90-day period, assessed by alkaline hematin method. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction. Cure from excessive bleeding: MBL in each episode \<80 mL + blood loss volume associated with each bleeding episode is decrease of ≥50% from average of qualifying bleeding episodes (with blood loss volume ≥80 mL per episode during run-in)
Menstrual Blood Loss Volume for All Participants at Cycle 1 Cycle 1 = 28 days (one cycle) Menstrual blood loss volume as assessed by the alkaline hematin method after patients were on treatment for one cycle. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Menstrual Blood Loss Volume for All Participants at Cycle 7 Cycle 7 = 28 days (one cycle) Menstrual blood loss volume as assessed by the alkaline hematin method after patients were on treatment for 7 cycles. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Proportion of Participants Cured From Frequent Bleeding Efficacy phase was defined as a 90-day period under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 Frequent bleeding: greater than 5 bleeding episodes, with a minimum of 20 bleeding days overall. Cure from frequent bleeding: no more than 4 bleeding episodes and the total number of bleeding days did not exceed 24 days and no increase from baseline in an individual patient's total number of bleeding days occurred
Proportion of Participants With Improvement in the Investigator's Global Assessment Scale at Treatment Day 196 From baseline (visit 5, day 1) up to treatment day 196 According to the investigator's global assessment scale "improved" was defined as being classified as 'very much improved', 'much improved', or 'improved' and "not improved" was defined as being classified as 'no change', 'worse', 'much worse', 'very much worse', or 'not assessed'. Central laboratory data, physical examination, e-diary data, and patient interview were used as sources for the assessment at day 196 compared with admission to study data.
Menstrual Blood Loss Volume for Participants With Excessive Bleeding at Cycle 3. Cycle 3 = 28 days (one cycle) Blood loss volume as assessed by the alkaline hematin method for participants with excessive bleeding (2 or more bleeding episodes each with blood loss volume of 80 ml or more during the run-in phase) after participants were on treatment for 3 cycles. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Menstrual Blood Loss Volume for Participants With Excessive Bleeding at Cycle 7. Cycle 7 = 28 days (one cycle) Blood loss volume as assessed by the alkaline hematin method for participants with excessive bleeding (2 or more bleeding episodes each with blood loss volume of 80 ml or more during the run-in phase) after participants were on treatment for 7 cycles. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Change From Baseline in Number of Bleeding Episodes to the Reference Period of 90 Days Under Treatment Baseline and reference period of 90 days under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 A bleeding episode is characterized by the following: • Bleeding for at least 2 days • Bleeding days can be separated by no more than 1 bleeding-free day • An episode stops with 2 consecutive bleeding-free days. The number of episodes was determined for the 90 days before treatment and for the 90 days under treatment. negative value indicates a reduction from baseline in the number of episodes while under treatment.
Change From Baseline in Blood Loss Volume for Participants With Excessive Bleeding to the Reference Period of 90 Days Under Treatment. Baseline and reference period of 90 days under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 Blood loss volume as assessed by the alkaline hematin method for participants with excessive bleeding (2 or more bleeding episodes each with blood loss volume of 80 ml or more during the run-in phase) for the 90 days before treatment (ie, run-in phase) and for the 90 days under treatment. A negative value indicates a reduction in blood loss while under treatment compared to before treatment.
Change From Baseline in Number of Bleeding Days to the Reference Period of 90 Days Under Treatment Baseline and reference period of 90 days under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 A bleeding day is a day on which sanitary protection is required. The number of bleeding days was determined for the 90 days before treatment (baseline) and for 90 days while under treatment. A negative value indicates a reduction in the number of bleeding days while under treatment compared to baseline.
Change From Baseline in Ferritin Concentration at Treatment Day 84 Baseline (visit 5, day 1) and treatment day 84 Ferritin was measured before treatment and after 84 days under treatment. A positive value indicates an increase in ferritin from baseline at treatment day 84.
Change From Baseline in Psychological General Well-Being Index (PGWBI) Score at Treatment Day 84. Baseline (visit 5, day 1) and treatment day 84 The PGWBI questionnaire consisted of 22 questions that were answered using a 6-grade Likert scale. The minimum overall score was 22 and the maximum 132. The higher the score, the better the well-being of the patient. The observation phase was the last 4 weeks. The following 6 dimensions were derived from the questionnaire: anxiety, depressed mood, positive well-being, self-control, health, and vitality and the highest possible scores were 30, 18, 24, 18, 18, and 24, respectively.
Resource Use Assessment by Use of a Self Administered Questionnaire （Productivity While Working） at Treatment Day 196. Treatment day 196 The patient was asked to rate on a scale of 0 to 10, how much her DUB affected her productivity while she was working during the past 12 weeks, where 0 represented that her DUB had no effect on her work and 10 represented that her DUB completely prevented her from working.
Resource Use Assessment by Use of a Self Administered Questionnaire （Unscheduled Outpatient Visit to Physician） at Treatment Day 196 Treatment day 196 The patient was asked if she had any unscheduled outpatient visits to a physician (non-hospital medical care) because of her DUB during the past 12 weeks, not including visits that were due to her participation in this study. She was also asked to indicate the number of visits. The proportion of participants with such visits are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Received Ambulatory Services） at Treatment Day 196 Treatment day 196 The patient was asked if she received ambulatory services (eg, home help, child care) because of her DUB during the past 12 weeks, and if yes, how many hours per week. The proportion of participants with such services are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （no Out-of-pocket Expenses） at Treatment Day 196 Treatment day 196 The patient was asked to specify her out-of pocket expenses because of her DUB during the past 12 weeks, including over-the-counter medication (the name of the medication, the number of packages, and the cost per package), co-payments due to prescribed medication, and costs to travel to and from medical appointments. The proportion of participants with no out-of pocket expenses are displayed.
Menstrual Blood Loss Volume for Participants With Excessive Bleeding at Cycle 1. Cycle 1 = 28 days (one cycle) Blood loss volume as assessed by the alkaline hematin method for participants with excessive bleeding (2 or more bleeding episodes each with blood loss volume of 80 ml or more during the run-in phase) after participants were on treatment for one cycle. This spectrophotometrical method measures hemoglobin (Hb) in fixed amount of alkaline solution, taken from pool of solution in which materials (used sanitary protection) to be tested have been macerated for Hb extraction.
Change From Baseline in Hemoglobin Concentration at Treatment Day 84 Baseline (visit 5) and treatment day 84 Hemoglobin was measured before treatment and after 84 days under treatment. A positive value indicates an increase in hemoglobin from baseline at treatment day 84.
Change From Baseline in Hemoglobin Concentration at Treatment Day 196 Baseline (visit 5) and treatment day 196 Hemoglobin was measured before treatment and after 196 days under treatment. A positive value indicates an increase in hemoglobin from baseline at treatment day 196.
Change From Baseline in Hematocrit at Treatment Day 196. Baseline (visit 5) and treatment day 196 Hematocrit was measured before treatment and after 196 days under treatment. A positive value indicates an increase in hematocrit from baseline at treatment day 196.
Change From Baseline in EuroQol 5 Dimensional (EQ-5D) Score at Treatment Day 196 Baseline (visit 5, day 1) and treatment day 196 The health state classification of the EQ-5D comprises 5 questions addressing mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Patients were asked to indicate their current health state by ticking the most appropriate of 3 statements about each of the questions (ie, no problems, some problems, extreme problems). The best possible answers were (1,1,1,1,1), which equals a valuation score of 1.0. The worst possible answers were (3,3,3,3,3), which equals a score of .594.
Resource Use Assessment by Use of a Self Administered Questionnaire （Days Missed From Work） at Treatment Day 84 Treatment day 84 The patient was asked how many days and hours she missed from work during the past 12 weeks because of her problems associated with her DUB, not including the time missed to participate in this study.
Change From Baseline in Number of Sanitary Protection Used at 90 Days of Treatment Baseline and reference period of 90 days under treatment. For patients who completed up to day 6 of treatment cycle 7, the efficacy phase started on the first day of treatment cycle 4, and continued through day 6 of treatment cycle 7 The number of total sanitary protection items used during the 90 days before treatment (baseline) and those used during the 90 days while under treatment was determined. A negative value indicates a reduction in the number of sanitary protection items used while under treatment compared to baseline.
Change From Baseline in McCoy Female Sexuality Questionnaire (MFSQ) Score at Treatment Day 84 Baseline (visit 5, day 1) and treatment day 84 The MFSQ was designed to measure aspects of female sexuality and asked about the patients´sexual experience during the last 4 weeks. Higher scores represent higher, more complete, or better integrated levels of female sexual function. Minimum and maximum values are 19 and 133.
Change From Baseline in McCoy Female Sexuality Questionnaire (MFSQ) Score at Treatment Day 196 Baseline (visit 5, day 1) and treatment day 196 The MFSQ was designed to measure aspects of female sexuality and asked about the patients´sexual experience during the last 4 weeks. Higher scores represent higher, more complete, or better integrated levels of female sexual function. Minimum and maximum values are 19 and 133.
Change From Baseline in EuroQol 5 Dimensional (EQ-5D) Score at Treatment Day 84 Baseline (visit 5, day 1) and treatment day 84 The health state classification of the EQ-5D comprises 5 questions addressing mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Patients were asked to indicate their current health state by ticking the most appropriate of 3 statements about each of the questions (ie, no problems, some problems, extreme problems). The best possible answers were (1,1,1,1,1), which equals a valuation score of 1.0. The worst possible answers were (3,3,3,3,3), which equals a score of .594.
Resource Use Assessment by Use of a Self Administered Questionnaire （Days Missed From Work） at Treatment Day 196 Treatment day 196 The patient was asked how many days and hours she missed from work during the past 12 weeks because of her problems associated with her DUB, not including the time missed to participate in this study.
Resource Use Assessment by Use of a Self Administered Questionnaire （Productivity While Working） at Treatment Day 84. Treatment day 84 The patient was asked to rate on a scale of 0 to 10, how much her DUB affected her productivity while she was working during the past 12 weeks, where 0 represented that her DUB had no effect on her work and 10 represented that her DUB completely prevented her from working.
Resource Use Assessment by Use of a Self Administered Questionnaire （Regular Daily Activities） at Treatment Day 196. Treatment day 196 The patient was asked to rate on a scale of 0 to 10, how much her DUB affected her ability to do her regular daily activities, other than work at a job, during the past 12 weeks, where 0 represented that her DUB had no effect on her daily activities and 10 represented that her DUB completely prevented her from doing her daily activities.
Resource Use Assessment by Use of a Self Administered Questionnaire （Unscheduled Outpatient Visit to Physician） at Treatment Day 84 Treatment day 84 The patient was asked if she had any unscheduled outpatient visits to a physician (non-hospital medical care) because of her DUB during the past 12 weeks, not including visits that were due to her participation in this study. She was also asked to indicate the number of visits. The proportion of participants with such visits are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Additional Unscheduled Procedures） at Treatment Day 84 Treatment day 84 The patient was asked if she had any unscheduled procedures (eg, laparoscopy, laboratory tests, ultrasound) because of her DUB during the past 12 weeks. The proportion of participants with such procedures are displayed.
Change From Baseline in Psychological General Well-Being Index (PGWBI) Score at Treatment Day 196. Baseline (visit 5, day 1) and treatment day 196 The PGWBI questionnaire consisted of 22 questions that were answered using a 6-grade Likert scale. The minimum overall score was 22 and the maximum 132. The higher the score, the better the well-being of the patient. The observation phase was the last 4 weeks. The following 6 dimensions were derived from the questionnaire: anxiety, depressed mood, positive well-being, self-control, health, and vitality and the highest possible scores were 30, 18, 24, 18, 18, and 24, respectively.
Change From Baseline in Visual Analogue Scale (VAS) of the EQ-5D Score at Treatment Day 196. Baseline (visit 5, day 1) and treatment day 196 The visual analogue scale (ie, "thermometer") had endpoints of 100 (best imaginable health state) at the top, and 0 (worst imaginable health state) at the bottom. Patients rated their current health state by drawing a line from the box marked "your own health state today" to the appropriate point on the thermometer scale.
Resource Use Assessment by Use of a Self Administered Questionnaire （Change in the Employment Status） at Treatment Day 196. Treatment day 196 The patient was asked if there was any change in her employment status in the last 12 weeks and was asked to specify the number of hours per week. The proportion of participants with such changes are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Regular Daily Activities） at Treatment Day 84 Treatment day 84 The patient was asked to rate on a scale of 0 to 10, how much her DUB affected her ability to do her regular daily activities, other than work at a job, during the past 12 weeks, where 0 represented that her DUB had no effect on her daily activities and 10 represented that her DUB completely prevented her from doing her daily activities.
Resource Use Assessment by Use of a Self Administered Questionnaire （Unscheduled Outpatient Visit at Hospital） at Treatment Day 196 Treatment day 196 The patient was asked if she had any unscheduled outpatient visits to a hospital because of her DUB during the past 12 weeks, not including visits that were due to her participation in this study. She was also asked to indicate the number of visits. The proportion of participants with any unscheduled outpatient visits are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Additional Unscheduled Procedures） at Treatment Day 196 Treatment day 196 The patient was asked if she had any unscheduled procedures (eg, laparoscopy, laboratory tests, ultrasound) because of her DUB during the past 12 weeks. The proportion of participants with such procedures are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （no Out-of-pocket Expenses） at Treatment Day 84 Treatment day 84 The patient was asked to specify her out-of pocket expenses because of her DUB during the past 12 weeks, including over-the-counter medication (the name of the medication, the number of packages, and the cost per package), co-payments due to prescribed medication, and costs to travel to and from medical appointments. The proportion of participants with no out-of pocket expenses are displayed.
Change From Baseline in Visual Analogue Scale (VAS) of the EQ-5D Score at Treatment Day 84. Baseline (visit 5, day 1) and treatment day 84 The visual analogue scale (ie, "thermometer") had endpoints of 100 (best imaginable health state) at the top, and 0 (worst imaginable health state) at the bottom. Patients rated their current health state by drawing a line from the box marked "your own health state today" to the appropriate point on the thermometer scale.
Resource Use Assessment by Use of a Self Administered Questionnaire （Change in the Employment Status） at Treatment Day 84. Treatment day 84 The patient was asked if there was any change in her employment status in the last 12 weeks and was asked to specify the number of hours per week. The proportion of participants with such changes are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Unscheduled Outpatient Visit at Hospital） at Treatment Day 84 Treatment day 84 The patient was asked if she had any unscheduled outpatient visits to a hospital because of her DUB during the past 12 weeks, not including visits that were due to her participation in this study. She was also asked to indicate the number of visits. The proportion of participants with any unscheduled outpatient visits are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Received Ambulatory Services） at Treatment Day 84 Treatment day 84 The patient was asked if she received ambulatory services (eg, home help, child care) because of her DUB during the past 12 weeks, and if yes, how many hours per week. The proportion of participants with such services are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Not Have Any Medical Treatment） at Treatment Day 84 Treatment day 84 The patient was asked if she had any medical treatment (eg, prescribed medication, other treatment) because of her DUB during the past 12 weeks, and to specify the cost. The proportion of participants with such treatment are displayed.
Resource Use Assessment by Use of a Self Administered Questionnaire （Not Have Any Medical Treatment） at Treatment Day 196 Treatment day 196 The patient was asked if she had any medical treatment (eg, prescribed medication, other treatment) because of her DUB during the past 12 weeks, and to specify the cost. The proportion of participants with such treatment are displayed.
Trial Locations
- Locations (36)
Private Practice Dr. Ian Fraser
🇦🇺Ashfield, New South Wales, Australia
Gynekologicko-poradnicka ambulance Dr. Hlavackova
🇨🇿Pisek, Czech Republic
emovis GmbH
🇩🇪Berlin, Germany
Praxis Hr. Dr. K. Greven
🇩🇪Hannover, Niedersachsen, Germany
Praxis Hr. Dr. S. Schönian
🇩🇪Rheinstetten, Baden-Württemberg, Germany
ClinPharm International GmbH
🇩🇪Dresden, Sachsen, Germany
SPSK nr 1
🇵🇱Lublin, Poland
Szpital Kliniczny nr 3
🇵🇱Poznan, Poland
Skånes Universitetssjukhus
🇸🇪Lund, Sweden
Karolinska Universitetssjukhuset Huddinge
🇸🇪Stockholm, Sweden
Dept. of obstetrics and gynaecology
🇺🇦Kiev, Ukraine
Akademiska Sjukhuset
🇸🇪Uppsala, Sweden
Lviv Regional Center Perinatal Center
🇺🇦Lviv, Ukraine
Bridge House Medical Centre
🇬🇧Cheadle, Cheshire, United Kingdom
Luton & Dunstable Hospital
🇬🇧Luton, United Kingdom
MeDiNova Research
🇬🇧Northwood, United Kingdom
King Edward Memorial Hospital
🇦🇺Subiaco, Western Australia, Australia
Terveystalo Lahti
🇫🇮Lahti, Finland
Selya Janos Hospital
🇭🇺Komarom, Hungary
Menox BV
🇳🇱Nijmegen, Netherlands
Kyiv Medical Academy of Postdyploma Education
🇺🇦Kiev, Ukraine
Praxis Hr. Dr. U. Kohoutek
🇩🇪Karlsruhe, Baden-Württemberg, Germany
University of Semmelweis
🇭🇺Budapest, Hungary
Ylioppilaiden terveydenhoitosäätiö, Turku
🇫🇮Turku, Finland
Borsod-Abauj-Zemplen County Hospital
🇭🇺Miskolc, Hungary
Medisch Spectrum Twente, Locatie Ariensplein
🇳🇱Enschede, Netherlands
Poliklinika Ginekologiczna- Poloznicza
🇵🇱Bialystok, Poland
Koskiklinikka
🇫🇮Tampere, Finland
PreCare Trial & Recruitment
🇳🇱Geleen, Netherlands
Instr. of Pediatrics, Obstetrics & Gynecology
🇺🇦Kiev, Ukraine
Center for Clinical& Basic Research
🇨🇿Pardubice, Czech Republic
Lekarsky dum Praha 7 a.s.Gynekologicka ambulance Dr. Jenicek
🇨🇿Praha 7, Czech Republic
Adenova Lääkärikeskus Oy
🇫🇮Espoo, Finland
Gynekologicka ambulance Vanda Horejsi, MD
🇨🇿Ceske Budejovice, Czech Republic
Instytut Centrum Zdrowia Matki Polki
🇵🇱Lodz, Poland
CSK MSWiA
🇵🇱Warszawa, Poland