Benefits and risks of pharmacological agents used for the treatment of menorrhagia.
Menorrhagia affects the lives of many women. The assessment of menstrual flow is highly subjective and gauging the severity of the condition by objective assessment of menstrual blood loss is impractical. In treating menorrhagia, the primary aim should be to improve quality of life. Women are willing to undergo quite invasive treatment in order to achieve this. Drug therapy is the initial treatment of choice and the only option for those who wish to preserve their reproductive function. Despite the availability of a number of drugs, there is a general lack of an evidence-based approach, marked variation in practice and continuing uncertainty regarding the most appropriate therapy. Adverse effects and problems with compliance also undermine the success of medical treatment. This article reviews the available literature to compare the efficacy and tolerability of different medical treatments for menorrhagia. Tranexamic acid and mefenamic acid are among the most effective first-line drugs used to treat menorrhagia. Despite being used extensively in the past, oral luteal phase norethisterone is probably one of the least effective agents. Women requiring contraception have a choice of the combined oral contraceptive pill, levonorgestrel-releasing intrauterine system (LNG-IUS) or long-acting progestogens. Danazol, gestrinone and gonadotropin-releasing hormone analogues are all effective in terms of reducing menstrual blood loss but adverse effects and costs limit their long-term use. They have a role as second-line drugs for a short period of time in women awaiting surgery. While current evidence suggests that the LNG-IUS is an effective treatment, further evaluation, including long-term follow up, is awaited. Meanwhile, the quest continues for the ideal form of medical treatment for menorrhagia--one that is effective, affordable and acceptable.
Roy
Samendra Nath
SN
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, United Kingdom. ogy218@abdn.ac.uk
Bhattacharya
Siladitya
S
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D003613:Danazol / Q000009:adverse effects / Q000627:therapeutic use; D004965:Estrogen Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D004979:Ethamsylate / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005867:Gestrinone / Q000009:adverse effects / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy*; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000933:Antifibrinolytic Agents; D003278:Contraceptives, Oral, Hormonal; D004965:Estrogen Antagonists; D011372:Progestins; D005867:Gestrinone; D004979:Ethamsylate; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol