Delivering Transcutaneous Auricular Neurostimulation to Reduce Heavy Menstrual Bleeding in Von Willebrand Disease Patients

Study Overview
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Brief Summary
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The objectives of this study are to determine if transcutaneous auricular neurostimulation (tAN) can modulate hemostasis, improve perceived quality of life, and improve pain during the menstrual cycle of von Willebrand Disease (VWD) patients.

Detailed Description
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This study is designed as an open label, decentralized clinical study in which patients with VWD and heavy menstrual bleeding (HMB) will receive tAN, which targets the auricular branch of the vagus nerve (ABVN) and the auriculotemporal nerve (ATN). Participants will be enrolled in the study over the course of two consecutive menstrual cycles. During the First Menstruation (baseline), no tAN treatment will be delivered. Participants will estimate blood loss and assess dysmenorrhea symptoms daily throughout the duration of the menstruation phase of their first menstrual cycle. A general quality of life assessment and total duration of menstruation will be collected on the final day of first menstruation. During the Second Menstruation, participants will self-administer 30 minutes of active tAN daily beginning Day 1 of menstruation through the final day of second menstruation. Participants will estimate blood loss and assess dysmenorrhea symptoms daily throughout the duration of the menstruation phase of their second menstruation. A general quality of life assessment and total duration of menstruation will be collected on the final day of second menstruation.

Official Title
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Delivering Transcutaneous Auricular Neurostimulation to Reduce Heavy Menstrual Bleeding in Patients With Von Willebrand Disease

Conditions
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Von Willebrand Disease, Type 1, Heavy Menstrual Bleeding

Intervention / Treatment
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* Device: Volta System


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Regularly menstruating female participants between 18-45 years of age Diagnosis of von Willebrand Disease Type 1 History of menorrhagia as assessed by the Menstrual Bleeding Questionnaire On oral birth control (at least three months) and willing to continue use for the duration of the study No changes to all current medications and supplements in the past three months, willingness to continue use for duration of study, and not start any new medications or homeopathic remedies Reliable access to an Internet-enabled device to complete required questionnaires Willingness to consistently use the same brand of tampons and/or pads throughout duration of the study Exclusion Criteria: Pregnancy within three months of enrollment Lactating at the time of enrollment Antifibrinolytic use within 30 days of enrollment Acquired bleeding disorder Use of anticoagulants (i.e., Aspirin, Warfarin, Coumadin, etc.) including platelet inhibitors for 30 days prior to enrollment Known structural cause of heavy menstrual bleeding Use of menstrual cups as a method of menstrual blood collection Participant has a history of chronic tobacco use or has ingested nicotine via smoking, vaping, smokeless tobacco, or nicotine patches in the past three months Participant has received a blood transfusion within 30 days prior to study Participant has a history of epileptic seizures Participant has a history of neurologic diseases or traumatic brain injury Participant has presence of devices (e.g., pacemakers, cochlear prostheses, neurostimulators) Participant has abnormal ear anatomy or ear infection present Participant has any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants are risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Participants with VWD and HMB will be enrolled in the study over the course of two consecutive menstrual cycles. First Menstruation will be baseline. Second Menstruation participants will self-administer 30 minutes of active tAN daily beginning Day 1 of second menstruation through the final day of second menstruation.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Baseline Followed by Active tAN<br>First Menstruation (baseline/no active tAN) followed by Second Menstruation (active tAN) | Device: Volta System<br>* The Volta System will be using the components of the Sparrow Ascent device: (FDA-cleared K230796) a wearable, battery-operated, neurostimulation system designed to transcutaneously stimulate nerves on and/or around the auricle. During Second Menstruation, participants will self-administer 30 minutes of active tAN daily with the Volta System Device beginning Day 1 of second menstruation through the final day of second menstruation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood loss during menses in von Willebrand Disease patients | Comparison of mean Pictorial Bleeding Assessment Chart (PBAC) scores during first menstruation (no stimulation) versus second menstruation (active stimulation). The PBAC is a widely accepted tool for patients with HMB to account for menstrual blood loss. Menstrual blood loss is estimated through a selection of images of tampons, pads, clots, and flooding events. Patients mark a tally next to the images that best match each of the menstruation products they used that day. This trial will utilize a modified version of the Wyatt et al. 2001 PBAC, where a tally system will be added to each of the images. | Daily throughout both menstruations (up to 2 complete menstrual cycles- estimated 60 days) | 
| Quality of Life of von Willebrand Disease patients | Comparison of mean quality of life score measured by the Short Form 36 (SF-36) during first menstruation (no stimulation) versus second menstruation (active stimulation). The SF-36 is a 36-item patient-reported questionnaire that assesses general quality of life. This questionnaire includes eight variables: physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, mental health, energy and vitality, pain, and general perception of health. The SF-36 is scored using a standardized scoring algorithm or by the SF-36 scoring software. The SF-36 scores range from 0 to 100, with higher scores representing better health status. | Daily throughout both menstruations (up to 2 complete menstrual cycles- estimated 60 days) | 
| Duration and severity of dysmenorrhea in von Willebrand Disease patients | Comparison of mean Cox Menstrual Symptom Scale (CMSS) scores during first menstruation (no stimulation) versus second menstruation (active stimulation). The CMSS measures menstrual distress and dysmenorrhea. The CMSS Severity subscale is an 18-item self-reported scale that measures severity of menstrual symptoms, including pain, nausea, emotions, etc. during menstruation. The CMSS will be used in this trial to measure a participant's dysmenorrhea every day of each menstruation. Each CMSS item is scored from 0-4, with a higher score indicating higher dysmenorrhea severity. | Daily throughout both menstruations (up to 2 complete menstrual cycles- estimated 60 days) | 
| Duration of menstruation in von Willebrand Disease patients | Compare duration of menstruation between first menstruation (no stimulation) versus second menstruation (active stimulation). | Daily throughout both menstruations (up to 2 complete menstrual cycles- estimated 60 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transcutaneous auricular vagus nerve stimulation, Neurostimulation, Hemostasis, Menstrual cycle, Menstruation, Blood loss