Medical management of dysfunctional uterine bleeding

Gillian Anne Irvine, Iain T. Cameron
In: Best Practice & Research Clinical Obstetrics & Gynaecology · 1999 · vol. 13(2) , pp. 189–202 · doi:10.1053/beog.1999.0017 · PMID:10755037 · W2055748849
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This review examines current medical treatments for dysfunctional uterine bleeding, focusing on hormonal and non-hormonal pharmacologic options.

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Abstract

Complaints of excessive menstrual bleeding (menorrhagia) have a substantial impact on gynaecological services and in most cases no organic pathology is identified. Up to 50% of women who present with menorrhagia have blood losses within the normal range. Medical therapy is indicated for patients who do not wish surgery, or for whom surgery is unsuitable. Nonsteroidal anti-inflammatory drugs and tranexamic acid offer a simple therapy to be taken during menses, with reductions in menstrual blood loss (MBL) of 25-35% and 50% respectively. Danazol and the gonadatrophin-releasing hormone analogues are highly effective, but their side-effects make them suitable only for short-term use. The combined oral contraceptive pill and the levonorgestrel intrauterine system give reductions in MBL of 50% and 80%, with additional contraceptive cover. Cyclical progestogens are the most commonly prescribed therapy in the United Kingdom but they are ineffective for the management of ovulatory menorrhagia unless taken at high doses (10-15 mg daily) for 3 weeks out of 4.

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