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TerminatedNCT05685199Updated Jan 28, 2026

Identifying the Determinants of Bleeding and Hypermobility in Patients With Heavy Menstrual Bleeding

An observational study in Hypermobile Ehlers-Danlos Syndrome, Heavy Menstrual Bleeding and Hypermobility Syndrome (Disorder), sponsored by St. Jude Children's Research Hospital. Terminated at 1 site in United States. Open to female participants aged 12 Years to 40 Years. Per ClinicalTrials.gov, last updated 2026-01-28.

Sponsored by St. Jude Children's Research Hospital · Observational

Why this study was terminated
Slow accrual
Study type
Observational
Model
Case-control
Time perspective
Prospective
Enrollment
15
Ages
12 Years to 40 Years
Sex
Female
01

Study summary

In this study, researchers want to learn about the connection between heavy bleeding issues and joint hypermobility (loose joints). They want to know if these issues may indicate other connective tissue problems in girls and women with heavy menstrual bleeding who do not have a known cause.

Primary Objective

  • Compare the severity of heavy menstrual bleeding (HMB) in women with and without Generalized joint Hypermobility Syndrome Disorder/hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) using bleeding scores.

Secondary Objectives

  • Compare the frequency of co-morbidities in women with and without G-HSD/hEDS.
Read the detailed description

Patients will be eligible for inclusion and offered to be screened for enrollment in this study if the duration of their menses was greater than or equal to 7 days, and they reported either "flooding" or bleeding through a tampon or napkin in 2 hours or less with most periods, have no identifiable bleeding disorder, and have evidence of severe iron deficiency anemia (hemoglobin \< 8 g/dL).

Once enrolled, joint hypermobility will be evaluated using a Beighton score which will be used to assign participants to two groups: with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS). Participants will then undergo a detailed clinical examination to further classify them using the 2017 diagnostic criteria and complete symptom questionnaires. Finally, participants will be consented to TBANK (NCT01354002) and INSIGHT HD (NCT02720679) to provide a sample of leftover blood for banking for future research. Participants will be seen annually for the next 3 years as part of their standard of care to document the course of their symptoms.

Visit 1: Self-BAT Questionnaire, Beighton Score examination, 2017 hEDS examination, PROMIS (Peds/Parent) questionnaire, PHQ15 questionnaire, COMPASS31 questionnaire, Menstrual distress questionnaire (ENDOPAIN), and Heavy menstrual bleeding checklist (both pediatric and adult).

Visit 2: Self-BAT Questionnaire, PROMIS (Peds/Parent) questionnaire, PHQ15 questionnaire, COMPASS31 questionnaire, Menstrual distress questionnaire (ENDOPAIN).

Visit 3: Self-BAT Questionnaire, PROMIS (Peds/Parent) questionnaire, PHQ15 questionnaire, COMPASS31 questionnaire, Menstrual distress questionnaire (ENDOPAIN).

Please note: At the present time patient enrollment is limited to St. Jude established patients only.

02

Conditions studied

  • Hypermobile Ehlers-Danlos Syndrome
  • Heavy Menstrual Bleeding
  • Hypermobility Syndrome (Disorder)

Keywords

  • Heavy Menstrual Bleeding
  • Joint Hypermobility
  • Hypermobile Ehlers-Danlos Syndrome
  • Generalized joint Hypermobility Syndrome Disorder
  • Loose Joints
03

Who can participate

Ages eligible
12 Years to 40 Years
Sexes eligible
Female
Sampling method
Non-probability sample

Study population

Participants who meet the Eligibility criteria and consent

Inclusion criteria

  • Female
  • Age 12-40 years
  • Presence of HMB
  • Evidence of severe iron-deficiency anemia (hemoglobin level of \< 8 g/dL)

Exclusion criteria

Exclusion Criteria:

  • Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.
  • Current use of anticoagulant and antiplatelet medications
  • Currently pregnant
  • Medical conditions that could cause HMB but are not necessarily a bleeding disorder, including, but not limited to:

    • Uncontrolled hypertension
    • Documented uterine structural abnormality
    • Insulin-dependent diabetes mellitus
    • Chronic kidney disease
    • Chronic liver disease
    • Thyroid disease
    • Documented peripheral arterial disease, venous or arterial vascular events in the past
    • A structural pathology that would explain the HMB
  • Presence of a bleeding disorder indicated by prothrombin time, activated partial thromboplastin time, fibrinogen, and von Willebrand factor activity, antigen and factor VIII
  • Persistent thrombocytopenia as defined by a platelet count of \<150,000/uL
  • If the participant answers "yes" to any of the following questions, they are ineligible:

    • Could the patient have a known connective tissue disorder?
    • Family history of sudden death
    • Family history/personal history of uterine rupture or bowel perforation
    • Family history/personal history of arterial rupture
    • Family history/personal history of aneurysm
    • Family history/personal history of an established EDS diagnosis based on genetic evaluation
04

Study design

Observational model
Case-control
Time perspective
Prospective
Enrollment
15 participants (actual)
Patient registry
No
Biospecimen retention
Samples with dna

Groups and cohorts

  • Case Group

    Participants with heavy menstrual bleeding (HMB)

  • Control Group

    Participants without heavy menstrual bleeding (HMB)

05

What researchers measure

Primary outcomes

  1. Severity of bleeding symptoms in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS): Self-Bleeding Assessment Tool (Self-Bat)

    Summary statistics of bleed score including mean, median, standard deviation and range will be reported for women with and without G-HSD/hEDS. The Self-BAT which consist of 14 categories for assessing bleeding symptom will be used. Each of the 14 variables is scored from 0-4 (except CNS bleeding when the scores are 0, 3 and 4) and on the basis of this a final score is derived. Scores of ≥ 3 in children, ≥ 4 in adult males and ≥ 6 in adult females is considered abnormal.

    Time frame: Yearly for 3 years

  2. Number of patients with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS).

    The number of patients with G-HSD/hEDS will be reported

    Time frame: Approximately 3 years

  3. Proportion of patients with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS).

    The proportion of patients with G-HSD/hEDS will be reported

    Time frame: Approximately 3 years

Secondary outcomes

  1. Co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) - PHQ15

    Investigators will compare co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) using PHQ 15. The PHQ-15 is a subscale of the full Patient Health Questionnaire (PHQ) and screens for 15 somatic symptoms. It scores symptom presence and severity on a 3-point Likert scale (0-2). The total score ranges from 0-30 with higher values indicating increased severity as follows: Minimal (0-4); Low (5-9); Medium (10-14); High (15-30).

    Time frame: Yearly for 3 years

  2. Co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS): Peds Patient-reported Outcomes Measurement Information System (PROMIS) 49 and Parent Proxy 49

    Investigators will compare co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) using Peds PROMIS 49 and Parent Proxy 49. The Peds PROMIS 49 is self-reported measures of global, physical, mental, and social health for children (ages 8-17) in the general population and those living with a chronic condition. The Parent Proxy 49 is intended for parents serving as proxy for their child (youth ages 5-17). PROMIS scores are reported as T scores ranging from 0-100. A higher PROMIS T-score represents more of the concept being measured. For negatively-worded concepts like Anxiety, a T-score of 60 is one SD worse than average. By comparison, an Anxiety T-score of 40 is one SD better than average. However, for positively-worded concepts like Physical Function-Mobility, a T-score of 60 is one SD better than average while a T-score of 40 is one SD worse than average.

    Time frame: Yearly for 3 years

  3. Co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS): PROMIS 57

    Investigators will compare co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) using adult PROMIS 57. The PROMIS 57 is for self-reporting measures of global, physical, mental, and social health for adults in the general population and those living with a chronic condition. PROMIS scores are reported as T scores ranging from 0-100. A higher PROMIS T-score represents more of the concept being measured. For negatively-worded concepts like Anxiety, a T-score of 60 is one SD worse than average. By comparison, an Anxiety T-score of 40 is one SD better than average. However, for positively-worded concepts like Physical Function-Mobility, a T-score of 60 is one SD better than average while a T-score of 40 is one SD worse than average.

    Time frame: Yearly for 3 years

  4. Co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS): Compass 31

    Investigators will compare co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS) using COMPASS31. The COMPASS31 contains 31 questions with Likert scales ranging in length from 2 to 6 items with higher scores indicating increased severity. COMPASS31 provides raw scores and standardized scores providing a total weighted score (0-100) of severity. The scale yields 6 subscales and a total score as follows: Orthostatic intolerance (4-10), Vasomotor (3-6); Secretomotor (4-7); Gastrointestinal (12-28); Bladder (3-9); Pupillomotor (5-15); Total (31-75)

    Time frame: Yearly for 3 years

  5. Co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS): Menstrual Distress Questionnaire

    Investigators will compare co-morbidities in women with and without Generalized joint Hypermobility Syndrome Disorder/ hypermobile Ehlers-Danlos Syndrome (G-HSD/hEDS)using the Menstrual Distress Questionnaire. This is a 21-element survey (ENDOPAIN 4D) which measures the gynecological and pelvic pain symptoms associated with periods. Each question is on a 11-point Likert scale with higher scores reflecting more severe symptoms or symptoms that most closely resemble the description.

    Time frame: Yearly for 3 years

06

Study locations

1 site
  • St. Jude Children's Research Hospital
    Memphis, Tennessee 38105, United States
07

References and documents

08

Registry details

Key details

Study ID
NCT05685199
Lead sponsor
St. Jude Children's Research Hospital
Collaborators
Wallace H. Coulter Foundation
Responsible party
Sponsor
First posted
Jan 17, 2023
Start date
May 10, 2024
Primary completion
Jan 6, 2026
Completion
Jan 6, 2026
Last update
Jan 28, 2026

Study contacts

Rohith Jesudas, MBBS
principal investigator · St. Jude Children's Research Hospital

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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