Effectiveness and mechanism of action of desmopressin in the treatment of copper intrauterine device-related menorrhagia: a pilot study.
BACKGROUND
Desmopressin, a synthetic analogue of the natural hormone vasopressin, stimulates endogenous haemostasis and exerts a powerful myometrial and vasoconstrictor action in a variety of pharmacological preparations. Both mechanisms of action may have therapeutic value for the treatment of intrauterine device (IUD)-related menorrhagia, which is believed to be caused not only by altered local haemostasis but also-according to a new hypothesis-by decreased vascular uterine resistance. The aim of this prospective study was to evaluate the effect of vasopressin drug on menstrual blood loss and on changes, if any, in uterine flow impedance. Mefenamic acid, which is commonly used to treat IUD-related menorrhagia, was administered as a comparison.


METHODS
Twenty-four women with IUD-induced menorrhagia were recruited and randomly allocated to treatment with either desmopressin or mefenamic acid. Menstrual blood loss (measured by pictorial blood loss assessment chart) and uterine artery resistance (measured with transvaginal colour Doppler) performed in two pretreatment periods were compared with 3-month treatment periods.


RESULTS
Menstrual blood loss was significantly reduced in both treatment groups. In the desmopressin group, the effect was clinically useful in all subjects, but in the mefenamic group menstrual blood loss was consistently menorrhagic in two patients. No significant differences were observed in the uterine artery pulsatility index before and during treatment.


CONCLUSIONS
Desmopressin may be a useful therapeutic tool for many women with IUD-related menorrhagia. Its mechanism of action lies in an ability to enhance local haemostasis, without affecting uterine blood flow.
Department of Obstetrics and Gynaecology of the University FedericoII, Naples Italy. fmercorio@libero.it
F
F
Mercorio
R
R
De Simone
C
C
Di Carlo
G
G
Bifulco
G
G
Tessitore
A
A
Di Spiezio Sardo
C
C
Nappi
D000328:Adult; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects*; D008528:Mefenamic Acid / Q000627:therapeutic use; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology*; D010865:Pilot Projects; D016896:Treatment Outcome
D016861:Cyclooxygenase Inhibitors; D006490:Hemostatics; D008528:Mefenamic Acid; D003894:Deamino Arginine Vasopressin