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Menorrhagia

Current Drug Treatment Concepts

  • Practical Therapeutic
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Summary

Since menorrhagia occurs in 9 to 14% of populations of healthy women, many general practitioners will encounter menorrhagia-related problems. Menorrhagia is difficult to objectify and the choice of treatment between the available drugs is not always an easy one. In this survey, the available knowledge on menorrhagia diagnosis, underlying pathophysiology and treatment, especially medicinal treatment, are discussed. Overall, a practical approach is emphasised.

The desire for contraception as well as the underlying cause of menorrhagia determine the drug of choice in the treatment of menorrhagia. If contraception is desired, oral combination contraceptives and continuously dosed progestogens, orally or as a medicated intrauterine device (IUD), are the first choice drugs for essential menorrhagia, and for fibroid- and bleeding disorderassociated menorrhagia. If no contraception is desired, the first choice treatments are drugs that need to be administered only during menstruation, such as prostaglandin synthesis inhibitors or antifibrinolytics. Of these, antifibrinolytics reduce menstrual blood loss to the greatest extent, whereas prostaglandin synthesis inhibitors have the lowest incidence of side effects. Prostaglandin synthesis inhibitors also have the extra advantage of diminishing dysmenorrhoea. There is no place for ergometrine in the treatment of menorrhagia.

No studies are available as yet on the combination of various drug treatment modalities, although such an evaluation would be desirable.

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References

  • Achiron A, Gornish M, Melamed E. Cerberal sinus thrombosis as potential hazard in antifibrinolytic treatment in menorrhagia. Stroke 21: 817–819, 1990

    Article  PubMed  CAS  Google Scholar 

  • Andersen B, Milsom I, Rybo G. An objective evaluation of fluriprofen and tranexamic acid in the treatment of idiopathic menorrhagia. Acta Obstetrica et Gynaecologica Scandinavica 67: 645–648, 1988

    Article  Google Scholar 

  • Anderson ABM, Haynes PJ, Guillebaud J, Turnbull AC. Reduction of menstrual blood loss by prostaglandin synthesis inhibitors. Lancet 1: 774–776, 1976

    Article  PubMed  CAS  Google Scholar 

  • Andersson JK, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. British Journal of Obstetrics and Gynaecology 97: 690–694, 1990

    Article  PubMed  CAS  Google Scholar 

  • Cameron IT, Haininh R, Lumsden MA, Thomas VR, Smith SK. The effects of mefenamic acid and norethisterone on menstrual blood loss. Obstetrics and Gynecology 76: 85–88, 1990

    PubMed  CAS  Google Scholar 

  • Chimbira TH, Anderson ABM, Turnbull AC. Relation between-measured menstrual blood loss and patient’s subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. British Journal of Obstetrics and Gynaecology 87: 603–609, 1980

    Article  PubMed  CAS  Google Scholar 

  • Christiaens GCML, Sixma JJ, Haspels AA. Morphology of haemostasis in menstrual endometrium. British Journal of Obstetrics and Gynaecology 87: 425–439, 1980

    Article  PubMed  CAS  Google Scholar 

  • Christiaens GCML, Sixma JJ, Haspels AA. Hemostasis in menstrual endometrium in the presence of an intrauterine device. British Journal of Obstetrics and Gynaecology 88: 825–837, 1981

    Article  PubMed  CAS  Google Scholar 

  • Cole SK, Billiwicz WZ, Thomson AM. Sources of variation of menstrual blood loss. British Journal of Obstetrics and Gynaecology 78: 933–939, 1971

    Article  CAS  Google Scholar 

  • Dockeray CJ, Sheppard BL, Bonnar J. Comparison between mefenamic acid and danazol in the treatment of established menorrhagia. British Journal of Obstetrics and Gynaecology 96: 840–844, 1989

    Article  PubMed  CAS  Google Scholar 

  • Fraser IS. Hysteroscopy and laparoscopy in women with menorrhagia. American Journal of Obstetrics and Gynecology 162: 1284–1289, 1990

    Google Scholar 

  • Fraser IS, McCarron G, Markham R, Resta T, Watts A. Measured menstrual blood loss in women with menorrhagia associated with pelvic disease or coagulation disorder. Obstetrics and Gynecology 68: 630–633, 1986

    PubMed  CAS  Google Scholar 

  • Goldrath MH, Fuller TA, Segal S. Laser photovaporization of endometrium for the treatment of menorrhagia. American Journal of Obstetrics and Gynecology 140: 14–19, 1981

    PubMed  CAS  Google Scholar 

  • Granström E, Swahn ML, Lundström V. The possible roles of prostaglandins and related compounds in endometrial bleeding: a mini review. Acta Obstetricia et Gynaecologica Scandinavica 113: 91–99, 1983

    Article  Google Scholar 

  • Guillebaud J, Bonnar J. Longer through lighter menstrual and intermenstrual bleeding with copper as compared to inert intrauterined devices. British Journal of Obstetrics and Gynaecology 85: 707–712, 1978

    Article  PubMed  CAS  Google Scholar 

  • Hahn L, Cederblad G, Rybo G, Pehrsson NG, Korsan-Bengsten K. Blood coagulation, fibrinolysis and plasma proteins in women with normal and excessive menstrual blood loss. British Journal of Obstetrics and Gynaecology 83: 974–980, 1976

    Article  PubMed  CAS  Google Scholar 

  • Hahn L, Petrusson B, The influence of acetylsalicylic acid and paracetamol on menstrual blood loss in women with and without an intrauterine contraceptive device. American Journal of Obstetrics and Gynaecology 135: 393–396, 19

  • Hall P, Maclachlan N, Thorn N, Nudd MWE, Taylor CG, et al. Control of menorrhagia by the cyclo-oxygenase inhibitor naproxen sodium and mefenamic acid. British Journal of Obstetrics and Gynaecology 94: 554–558, 1987

    Article  PubMed  CAS  Google Scholar 

  • Hallberg L, Hoegdahl A, Nilsson L. Rybo G. Menstrual blood loss: a population study. Acta Obstetricia et Gynaecologica Scandinavica 45: 320–351, 1966

    Article  CAS  Google Scholar 

  • Haynes PJ, Hodgson H, Anderson ABM. Measurement of menstrual blood loss in patients complaining of menorrhagia. British Journal of Obstetrics and Gynaecology 84: 763–768, 1977

    Article  PubMed  CAS  Google Scholar 

  • Higham JM, O’Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. British Journal of Obstetrics and Gynaecology 97: 734–739, 1990

    Article  PubMed  CAS  Google Scholar 

  • Kasonde JM, Bonnar J. Aminocaproic acid and menstrual loss in women using intrauterine devices. British Medical Journal 4: 17–19, 1975

    Article  PubMed  CAS  Google Scholar 

  • Kasonde JM, Bonnar J. Effect of sterilisation on menstrual blood loss. British Journal of Obstetrics and Gynaecology 83: 572–573, 1976

    Article  PubMed  CAS  Google Scholar 

  • Magos AL, Baumann R, Turnbull AC. Transcervical resection of endometrium in women with menorrhagia. British Medical Journal 298: 1209–1212, 1989

    Article  PubMed  CAS  Google Scholar 

  • Mäkäräinen L, Ylikorkala O. Primary and myoma-associated menorrhagia: role of prostaglandins and effect of ibuprofen. British Journal of Obstetrics and Gynaecology 93: 974–978, 1986

    Article  PubMed  Google Scholar 

  • Meyer WR, Mayer AR, Diamond MP, Carangiu ML, et al. Unsuspected leiomyosarcoma: treatment with a gonadotrophin-releasing hormone analogue. Obstetrics and Gynecology 75: 529–531, 1990

    PubMed  CAS  Google Scholar 

  • Milsom I, Andersson K, Andersch B, Rybo G. A comparison of flubiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia. American Journal of Obstetrics and Gynecology 164: 879–883, 1991

    PubMed  CAS  Google Scholar 

  • Newton J, Barnard G, Gollins W. A rapid method for measuring menstrual blood loss using automatic extraction. Contraception 16: 269–282, 1977

    Article  Google Scholar 

  • Nilsson IM, Bjorkman SE. Experiences with epsilon amino caproic acid (EACA) in the treatment of profuse menstruation. Acta Medica Scandinavica 177: 445–457, 1965

    PubMed  CAS  Google Scholar 

  • Nilsson L, Rybo G. Treatment of menorrhagia. American Journal of Obstetrics and Gynecology 110: 713–720, 1971

    PubMed  CAS  Google Scholar 

  • Owen PR, Prostaglandin synthetase inhibitors in the treatment of primary dysmenorrhoea. American Journal of Obstetrics and Gynecology 148: 96–102, 19

  • Pedron N, Lozano M, Gallegos AJ. The effect of acetylsalicylic acid on menstrual blood loss in women with IUDs. Contraception 36: 295–303, 1987

    Article  PubMed  CAS  Google Scholar 

  • Phipps JH, Lewis BV, Roberts T, Prior MV, Hand JW, et al. Treatment of functional menorrhagia by radiofrequency-induced thermal endometrial ablation. Lancet 335: 374–376, 1990

    Article  PubMed  CAS  Google Scholar 

  • Roy S, Shaw ST. Role of prostaglandins in IUD-associated uterine bleeding: effect of a prostaglandin synthesis inhibitor (ibu-profen). Obstetrics and Gynecology 58: 101–106, 1981

    PubMed  CAS  Google Scholar 

  • Rybo G. Plasminogen activators in the endometrium. Acta Obstetricia et Gynaecologica Scandinavica 45: 411–450, 1966

    Article  CAS  Google Scholar 

  • Rybo G. Physiological causes of iron defiency in women: menstruation and pregnancy. Clinics in Hematology 2: 269–290, 1973

    Google Scholar 

  • Sahwi S, Toppozada M, Kamel M, Anwar MY, Ismail AAA. Changes in menstrual blood loss after four methods of female tubal sterilization. Contraception 40: 387–398, 1989

    Article  PubMed  CAS  Google Scholar 

  • Scott JC, Mussey E. Menstrual patterns in myxedema. American Journal of Obstetrics and Gynecology 90: 161–165, 1964

    PubMed  Google Scholar 

  • Scholten PC, Christiaens GCML, Haspels AA. Intrauterine steroid contraception. Wiener Medizinische Wochenschrift 137: 497–483, 1987

    Google Scholar 

  • Shaw ST, Aaronson DE, Moyer DL. Quantitation of menstrual blood loss: further evaluation of the alkaline hematin method. Contraception 5: 497–513, 1972

    Article  PubMed  Google Scholar 

  • Shaw RW, Fraser HM. Use of a superactive luteinizing hormone releasing hormone (LHRH) agonist in the treatment of menorrhagia. British Journal of Obstetrics and Gynaecology 91: 913–916, 1984

    Article  PubMed  CAS  Google Scholar 

  • Smith SK, Abel MH, Kelly RW, Baird DT. Prostaglandin synthesis in the endometrium of women with ovular dysfunctional bleeding. British Journal of Obstetrics and Gynaecology 88: 434–442, 1981

    Article  PubMed  CAS  Google Scholar 

  • Townsend DE, Richart RM, Paskowitz RA, Woolfork RE. ‘Rollerball’ coagulation of the endometrium. Obstetrics and Gynecology 76: 310–303, 1990

    PubMed  CAS  Google Scholar 

  • Turnbull AC, Rees MCP. Gestrinone in the treatment of menorrhagia. British Journal of Obstetrics and Gynaecology 97: 713–715, 1990

    Article  PubMed  CAS  Google Scholar 

  • van Eijkeren MA, Christiaens GCML, Geuze HJ, Haspels AA, Sixma AA. Morphology of menstrual hemostasis in essential menorrhagia. Laboratory Investigation 64: 284–294, 1991

    PubMed  Google Scholar 

  • van Eijkeren MA, Christiaens GCML, Haspels AA, Sixma JJ. Measured menstrual blood loss in women with a bleeding disorder or using oral anticoagulant therapy. American Journal of Obstetrics and Gynecology 162: 1261–1263, 1990

    PubMed  Google Scholar 

  • van Eijkeren MA, Scholten PC, Christiaens GCML, Aisbach GPJ, Haspels AA. The alkaline hematin method for measuring menstrual blood loss: a modification and its clinical use in menorrhagia. European Journal of Obstetrics, Gynecology and Reproductive Biology 22: 345–351, 1986

    Article  Google Scholar 

  • von Vinazzer H, Über Störungen der Haemostase als Urasche von Menorrhagien. Zeitschrift für Geburtshilfe und Frauenheilkunde 26: 743–745, 19

  • Wester J, Sixma JJ, Geuze JJ, Heijnen HFG. Morphology of the hemostatic plug in human skin wounds: transformation of the plug. Laboratory Investigation 41: 182–192, 1979

    PubMed  CAS  Google Scholar 

  • Wilansky DL, Greisman B, Early hypothyroidism in patients with menorrhagia. American Journal of Obstetrics and Gynecology 160: 673–677, 19

  • Ylikorkala O, Kaupilla A, Siljander M. Antiprostaglandin therapy in prevention of side effects in intrauterine contraceptive devices. Lancet 2: 393–394, 1978

    Article  PubMed  CAS  Google Scholar 

  • Ylikorkala O, Pekonen F. Naproxen reduces idiopathic but not fibromyoma-induced menorrhagia. Obstetrics and Gynecology 68: 10–12, 1986

    PubMed  CAS  Google Scholar 

  • Ylikorkala O, Viinikka L. Comparison between antifibrolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices. British Journal of Obstetrics and Gynaecology 90: 78–83, 1983

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University Hospital Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands

    M. A. van Eijkeren, G. C. M. L. Christiaens, P. C. Scholten & J. J. Sixma

  2. Department of Haematology, University Hospital Utrecht, Utrecht, The Netherlands

    M. A. van Eijkeren, G. C. M. L. Christiaens, P. C. Scholten & J. J. Sixma

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  1. M. A. van Eijkeren
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  2. G. C. M. L. Christiaens
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  3. P. C. Scholten
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  4. J. J. Sixma
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van Eijkeren, M.A., Christiaens, G.C.M.L., Scholten, P.C. et al. Menorrhagia. Drugs 43, 201–209 (1992). https://doi.org/10.2165/00003495-199243020-00006

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