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The treatment of unexplained menorrhagia

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Summary

THE most comonly used medical therapies for the treatment of mennorrhagia have been progestogens alone or combined with an oestrogen, and antifibrinolytic drugs. Most recently, prostaglandin synthetase inhibitors have been shown to reduce menstrual blood loss in some women. This paper reviews the use of danazol in the treatment of women complaining of regular but heavy menstrual blood loss and in whom objective measurements of blood loss were made. Eighteen patients with menorrhagia (more than 80 ml menstrual blood loss) were treated with danazol 400 mg daily for 12 weeks. Danazol significantly reduced the menstrual blood loss loss from 231 ± 39ml (mean ± SEM) to 135±33 ml in the first treatment month, and the mean loss thereafter was only 21 ml and 3 ml for the second and third months respectively. A rapid increase in haemoglobin level, and a reduction in the number of days of bleeding were also observed on danazol treatment. No important effect on the coagulation profile was observed during the period of study. Three months after stopping danazol, menstrual blood loss (103 ± 27 ml) was still significantly less than the pre-treatment loss. Because of side-effects of weight gain and muscle cramps in some patients, a smaller dose of danazol, 200 mg daily, has since been evaluated. This dose effectively reduced menstrual loss to acceptable amounts, with continuing regular menstrual periods in most women, and greatly reduced the incidence of side-effects of the drug.

Menorrhagia, which signifies heavy but regular menstrual blood losses, is the commonest symptom with which patients present at the gynaecological clinic. This abnormality may be due to an aberration of function, or herald gross but generally benign disease. It accounts for 25 per cent of patientsattending our own clinic and in one-half of these there is no detectable pathoogy.

We are now seeing an increasing number of patients who naturally have either long or short cycles which they have previously accepted as normal, but who have become worried by an article on cancer in the popular press or by an invitation to have a cervical smear.

There are wide variations of normal menstruation and each woman has her own patterns, which is as much a part of her make-up as the colour of her hair and subject equally to natural or artificial change. No investigation or treatment is necessary for naturally short or long cycles unless they are associated with infertility, inconvenience or a loss so heavy as to cause anaemia. Nevertheless,any change should be investigated immediately as a new pattern may signify malignancy.

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Cope, E. The treatment of unexplained menorrhagia. Ir J Med Sci 152 (Suppl 2), 29–32 (1983). https://doi.org/10.1007/BF02945279

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