A benefit-risk review of systemic haemostatic agents: part 2: in excessive or heavy menstrual bleeding.
The first part of this benefit-risk review examined the efficacy and adverse effect profiles of systemic haemostatic agents commonly used in major surgery. The second part of this review examines the efficacy and adverse effect profiles of systemic haemostatic agents commonly used in the treatment of excessive or heavy menstrual bleeding, and provides individual benefit-risk profiles that may assist clinicians in selecting appropriate pharmacological therapy in this setting. Historically, surgery has played a dominant role in treatment; however, pharmacological therapy is increasingly popular, especially in women who wish to retain their fertility. When selecting the appropriate treatment, patient preference should be considered, as well as the benefits and risks associated with each agent. Recommended pharmacological therapies that are effective and generally well tolerated include the levonorgestrel-releasing intrauterine system and the oral agents tranexamic acid, NSAIDs (e.g. mefenamic acid) and combined estrogen/progestogen oral contraceptives. In patients with an underlying bleeding disorder (e.g. von Willebrand disease), an additional option is intranasal desmopressin.
Fraser
Ian S
IS
Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, Australia. helena@obsgyn.usyd.edu.au
Porte
Robert J
RJ
Kouides
Peter A
PA
Lukes
Andrea S
AS
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003613:Danazol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008595:Menorrhagia / Q000188:drug therapy*; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003277:Contraceptives, Oral, Combined; D006490:Hemostatics; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone; D016912:Levonorgestrel; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin; D003613:Danazol