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PubMed2001

The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review.

OBJECTIVE: To determine whether the levonorgestrel-releasing intrauterine device (LNG-IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings. METHODS: A systematic review addressing the effectiveness and cost effectiveness of the LNG-IUS for menorrhagia was undertaken. RESULTS: Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG-IUS (range 74%-97%). Another showed reduction in menstrual disturbance score. The LNG-IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found. DISCUSSION: Small studies of moderate quality indicate the LNG-IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up. CONCLUSION: Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient-centred outcomes in women with menorrhagia.

Adult↗
PubMed1991

Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia.

A series of 45 ovulatory women with a complaint of menorrhagia were randomized into 3 treatment groups, before receiving therapy with mefenamic acid in 2 cycles and 1 of 3 other agents in 2 cycles: naproxen (group 1; n = 14), a low dose monophasic combined oral contraceptive (group 2; n = 12) or low dose danazol (group 3; n = 12). Menstrual blood loss was measured in 2-4 control cycles and during therapy. Mefenamic acid reduced measured blood loss by 20%; 38%; and 39% in groups 1-3 respectively. Naproxen reduced blood loss by 12%; the oral contraceptive by 43%; and danazol by 49%. There was no statistically significant difference in blood loss reduction (mean of 2 cycles) between any of the treatments, although women on danazol experienced a dramatic and highly significant further reduction in blood loss after the first treatment cycle (p less than 0.003). These were all effective therapies in a majority of women, but some 'non-responders' were seen in each group. The 'non-responders' had a significantly lower pretreatment blood loss than responders. Several women in group 1 showed anomalous responses to prostaglandin inhibitors with consistent and substantial exacerbation of menorrhagia during therapy. A number of reasonable therapies exist for the medical treatment of menorrhagia, but because none is suitable for everyone management needs to be individualized for each patient.

Contraceptives, Oral, Combined↗
PubMed1995

von Willebrand disease: a rare cause of puberty menorrhagia.

A 13-year-old girl with a family history of epistaxis presented with pubertal menorrhagia necessitating multiple blood transfusions. Her coagulation profile confirmed the diagnosis of Von Willebrand disease. The menorrhagia was controlled by cyclical use of oestrogen progestogen combination drugs. The important clinical implication of this case is that the patient with adolescent menorrhagia may have an underlying coagulation disorder, which can successfully be managed by hormones.

Adolescent↗
PubMed2005

Bleeding disorders in teenagers presenting with menorrhagia.

OBJECTIVE: To assess the prevalence of bleeding disorders and establish the clinical variables that are predictive of a bleeding disorder in adolescent women. DESIGN: A retrospective audit of all patients who had coagulation tests following presentation with menorrhagia. SETTING: Inpatient and outpatients of a tertiary adolescent gynaecology service. PATIENTS: Subjects aged 9-19 years with menorrhagia who had coagulation tests performed, and who did not have a known bleeding disorder prior to presentation were included. OUTCOME MEASURES: A bleeding screen was performed to assess prevalence of bleeding disorders in the population. Variables that were investigated as predictive of a bleeding disorder included clinical history, family history, and haematological indices of blood loss. RESULTS: The prevalence of an inherited bleeding disorder was 10.4%. The only statistically significant predictor was a family history of bruising and bleeding. Menstrual history was not predictive. CONCLUSION: Severity of menstrual loss was not predictive of a bleeding disorder, as a significant cause of teenage metrostaxis is due to anovulatory dysfunctional uterine bleeding. The authors recommend that a careful personal and family history of bruising and bleeding be taken in all teenagers who present de novo with menorrhagia. Routine screening in a primary care setting is impractical, but should be mandatory in all patients with a positive family history.

Adolescent↗
PubMed2000

Management of menorrhagia in primary care-impact on referral and hysterectomy: data from the Somerset Morbidity Project.

OBJECTIVE: To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates. DESIGN: Prospective observational study. SETTING: 11 general practices from the Somerset Morbidity Project. SUBJECTS: 885 women consulting their general practitioner with menorrhagia over four years. MAIN OUTCOME MEASURES: Proportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between investigation and prescribing in primary care and referral to and surgery in secondary care. RESULTS: Less than half of women had a vaginal examination (42%, 95% CI 39% to 45%), or a full blood count (39%, 95% CI 36% to 43%). Almost a quarter of women, 23% (95% CI 20% to 26%), received no drugs and 37% (95% CI 34% to 40%) received norethisterone. Over a third, 38% (95% CI 34% to 40%), of women were referred, and once referred 43% (95% CI 38% to 48%) of women were operated on. Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and/or mefenamic acid in primary care (chi(2)=16.4, df=1, p<0.001). There were substantial between practice variations in management, for example in prescribing of tranexamic acid and/or mefenamic acid (range 16% to 72%) and referral to gynaecology (range 24% to 52%). There was a significant association between high referral and high operative rates (Spearman's correlation coefficient=0.86, p=0.001). CONCLUSIONS: Substantial differences in management exist between practices when investigating and prescribing for menorrhagia in primary care. Rates of prescribing of effective medical treatment remain low. The decision to refer a woman impacts markedly on her chances of subsequently being operated on. Effective management in primary care may not reduce referral or hysterectomy rates.

Adult↗
PubMed2006

Health status function after treatment with thermal balloon endometrial ablation and levonorgestrel intrauterine system for idiopathic menorrhagia: a randomized study.

AIM: To compare patients' health status function after treatment with thermal balloon endometrial ablation (TBEA) and levonorgestrel intrauterine system (LNG-IUS) for idiopathic menorrhagia. METHODS: Forty-four patients were recruited into a randomized trial comparing their health status after treatment with TBEA or LNG-IUS for idiopathic menorrhagia. RESULTS: At 1 year follow-up, the mean haemoglobin was significantly higher in women treated with TBEA (12.6 g/dl vs. 10.3 g/dl, p = 0.018). Iron deficiency occurred in 13.3% from the TBEA arm and in 50% from the LNG-IUS arm (p = 0.026). The women's mean Short Form 36 Questionnaire general health perception scores (54.9 vs. 40.5, p = 0.024) and mental health scores (49.5 vs. 38.3, p = 0.021) in TBEA arm were significantly higher than in the LNG-IUS arm. The mental health domain score was also significantly lower in the LNG-IUS arm (46.1 vs. 38.3, p = 0.041). CONCLUSION: TBEA appears to offer better health status function at 1 year follow-up and to be more acceptable to our Chinese population in the treatment of idiopathic menorrhagia following failed medical treatment.

Adult↗
PubMed2000

First-line management of menorrhagia: findings from a survey of general practitioners in Forth Valley.

This study was undertaken to determine local GPs' current management of menorrhagia, prior to the release of the Royal College of Obs tetricians and Gynaecologists' (RCOG) guideline on the initial management of menorrhagia. A postal questionnaire was sent to 204 GPs in the Forth Valley area. An 84% (n = 173) response rate was recorded. Responses were compared with RCOG guideline recommendations after its release. Fifty-two percent of respondents measured a full blood count and 56% performed a pelvic examination. Two thirds of GPs chose the recommended treatments (mefenamic acid or tranexamic acid) as their first or second choice of treatment in women not requiring contraception. One third chose cyclical progestogens. Only 10% of GPs selected an ineffective treatment (cyclical progestogens) as their first or second choice of treatment in women requiring contraception. This survey demonstrates that the majority of GPs are already prescribing the treatments recommended in the RCOG guidelines. There is a need for education amongst a minority to improve their practice. Half of the GPs reported compliance with the recommended investigations of full blood count and pelvic examination. The point at which these investigations are performed in the initial management of menorrhagia may need further discussion between primary and secondary care clinicians to clarify their purpose.

Data Collection↗
PubMed2004

Modern management of menorrhagia.

Menorrhagia, defined clinically as menstrual blood loss in excess of 80 ml per cycle, is a common gynaecological complaint that presents both to primary and secondary care. The aim of this review of the literature is to discuss current opinion in the investigation and management of menorrhagia. As menorrhagia is a subjective condition that is difficult and impractical to assess objectively, this review incorporates patient-centred outcomes such as patient satisfaction and continuation with treatment together with more traditional outcomes such as percentage reduction in menstrual loss. As there are many treatment options available, with no one option being superior in all respects, patient choice and treatment preferences should be taken into account when deciding upon management.

Adult↗
PubMed1993

Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas.

OBJECTIVE: To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia. DESIGN: Prospective, comparative, nonrandomized study. SETTING: A teaching hospital of Milano University. PATIENTS: Anemic women requiring hysterectomy for myoma-associated menorrhagia. INTERVENTION: Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls). MAIN OUTCOME MEASURES: Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital. RESULTS: In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units. CONCLUSIONS: In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.

Adult↗
PubMed1999

[Menorrhagia, hypermenorrhea and disorders of hemostasis].

Menorrhagia is a common clinical problem. About 10% of women aged between 30 and 49 take medical advice for abnormal uterine bleeding. Underlying bleeding disorders are found in about 20% of women, once pelvic abnormalities are excluded. It is important to characterize a bleeding disorder since specific treatments can be provided. Moreover, these women are susceptible to present other haemorrhagic complications, particularly in case of invasive procedures. This review aims at drawing the attention a) on the importance of a careful medical history to assess menorrhagia and a possible bleeding disorder, b) on von Willebrand disease, the main coagulation disorder involved in case of menorrhagia and c) on several therapeutic possibilities.

Blood Coagulation Disorders↗
PubMed2001

Medium-term clinical outcome of women with menorrhagia treated by rollerball endometrial ablation versus abdominal hysterectomy with conservation of at least one ovary.

BACKGROUND: To compare patients' satisfaction, health related quality of life, and sexual function among women who were either treated with rollerball endometrial ablation or abdominal hysterectomy with conservation of at least one ovary for the treatment of menorrhagia. METHOD: Between March 1992 to June 1997, 91 women underwent rollerball endometrial ablation and 78 women had abdominal hysterectomy with preservation of at least one ovary for the treatment of intractable menorrhagia. Each was sent a detailed questionnaire at least 18 months (range 18-60) after surgery. Case notes were reviewed to collect additional data relating to pre-operative management and operative details. RESULTS: Of 169 women, 120 (71%) returned a completed questionnaire [80/91 women (88%) had ablation and 40/78 women (51%) had hysterectomy]. Non-response analysis did not reveal any differences in prognostic characteristics between responders and non-responders. The length of hospital stay and time taken to return to normal daily activity were significantly less in the ablation group. Pre-menstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvement in general health higher. Women who had hysterectomy were more satisfied (100% versus 79%) and would be more likely to recommend it to a friend (100% versus 91%). CONCLUSION: Both procedures are effective for the treatment of menorrhagia but hysterectomy is associated with better general health and fewer pre-menstrual symptoms. Rollerball ablation is a useful alternative with many short term benefits and acceptable satisfaction rate. Further work is required to evaluate long term effects.

Adolescent↗
PubMed2001

Treatment of menorrhagia with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study.

OBJECTIVE: To evaluate the effect on menstrual blood loss of a novel 'frameless' intrauterine drug delivery system, the FibroPlant levonorgestrel intrauterine system (IUS), releasing 14 microg of levonorgestrel/day. An ancillary objective was to evaluate the contraceptive performance. STUDY DESIGN: This was an open-label, non-comparative ongoing pilot study. Thirty-two insertions were performed in fertile women aged between 31 and 51 years for the treatment of menorrhagia, as well as for contraceptive purposes. Fifteen women who developed excessive bleeding were fitted with the FibroPlant levonorgestrel IUS immediately following the removal of a copper-bearing intrauterine device (IUD), the GyneFix IUD. To discriminate between menorrhagia and normal menstrual blood loss, women were evaluated using a simple visual assessment technique. The trial covered a period from a minimum of 1 month up to 23 months. RESULTS: At the time of study analysis, the total number of woman-months was 361. Fourteen of the women had had the FibroPlant levonorgestrel IUS in place for more than 1 year, and 29 women for 6 months or more. All women reported greatly reduced bleeding. However, no cases of amenorrhea resulting from endometrial suppression were encountered. The reduction of bleeding was substantial after 1 month of treatment and decreased further over the next months to remain stable thereafter. The mean bleeding score before treatment was 338 (range 185-740) in the group who had had no prior use of an IUD and 368 (range 185-890) in the group with prior IUD use. The mean bleeding score dropped to a mean score of 70 (range 5-210) in the 'no prior IUD use' group and to a mean score of 52 (range 3-150) in the 'prior IUD use' group, after 1-23 months of follow-up. This result is highly statistically significant (p < 0.001). There were no statistical differences in bleeding scores before and during treatment between the two groups of women, with or without prior use of the copper IUD. Significant spotting was rare after the first 3 months following insertion. No complications (e.g. infection, expulsion or perforation) or pregnancies occurred. The FibroPlant levonorgestrel IUS was well tolerated by all women involved in the study and no systemic hormonal side-effects were reported. CONCLUSION: The FibroPlant levonorgestrel IUS is effective in significantly reducing the amount of menstrual blood loss in women with menorrhagia. Strong endometrial suppression is the principal mechanism explaining both the effect on menstrual blood loss and the contraceptive performance of the IUS. There were no differences in bleeding scores before and during treatment between the two groups of women with or without prior use of the copper IUD, suggesting that the development of heavy bleeding was not related to the use ofthe IUD. The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemia in developing countries, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The low daily release rate of levonorgestrel from the FibroPlant levonorgestrel IUS results in a low incidence of hormonal side-effects and reduces the likelihood of amenorrhea. The simple design characteristics and revolutionary anchoring system minimize the occurrence of complaints of pain and the incidence of expulsion.

Adult↗
PubMed2003

[Treatment of menorrhagia--a surgical or medical approach?].

OBJECTIVE: A comparison of surgical and medical approaches to the therapy of menorrhagia. DESIGN: A review article. SETTING: Obstetrics and Gynaecological Department of the Masaryk Hospital in Ustí nad Labem. SUBJECT: A comparison is made of advantages and disadvantages of different types of therapy of menorrhagia after introduction of minimal-invasive techniques of endometrial ablation. Details are given of the comparison of standard and global techniques of endometrial ablation and hysterectomy. Results of several randomised studies, especially retreatment rate, patient's satisfaction and cost-effectiveness are compared. CONCLUSION: Endometrial ablation is an accepted standard alternative to hysterectomy for therapy of menorrhagia; it is not intended to replace hysterectomy. Hysterectomy ought to be the second-line treatment after ablation failures or for noncandidates for ablation. Mini-invasive techniques may be used as the first-line surgical option instead of medical therapy. Standard methods of endometrial ablation give 8-9 in 10 women definite chance of avoiding hysterectomy. Global techniques must be assessed in randomised studies. The individualisation of therapy and detailed information given to women lead to higher satisfaction with their treatment outcome.

Female↗
PubMed2004

[Von Willebrand disease in women with menorrhagia].

Excessive menstrual bleeding is a common clinical problem in women of reproductive age. Hereditary bleeding disorders, such as von Willebrand disease, may be one of the causes of menorrhagia. The aim of our study was to assess the frequency of von Willebrand disease and other hemostatic defects in women with unexplained menorrhagia and without uterine pathology. Sixty-five women (mean age 31 +/- 8.7, range 18-48 years) presenting with menorrhagia were screened. An inherited bleeding disorder was diagnosed 9 (13.8%) patients; the disorders were von Willebrand disease of mild severity (type 1) in 8 cases (12.3%) and a platelet dysfunction (storage pool disease) in 1. The frequency of bleeding symptoms was higher in patients with an inherited hemostatic defect than in women without bleeding disorder. The results of this study underscore the need for hemostatic evaluation in women with excessive menstrual bleeding and without obvious pelvic abnormality.

Adult↗
PubMed2004

[Study on clinical efficacy and mechanism of xiaoyan zhixue capsule in treating menorrhagia caused by intrauterine device].

OBJECTIVE: To observe the efficacy of Xiaoyan Zhixue Capsule (XYZXC) in treating uterus abnormal menorrhagia caused by intrauterine device (IUD) and to study its mechanism. METHODS: IUD users with menorrhagia were randomly divided into two groups, the XYZXC treated group and adrenosoem (AC-17) control group. Endometrial tissue of XYZXC treated group before and after treatment were taken out to observe its morphologic change with optic and electronic microscope. Animal experiment was done to observe the effect of XYZXC in eliminating inflammation of patierts, and the relevant parameters were monitored. RESULTS: Clinical efficacy: (1) Total effective rate of the treated group was 90.3%, that of control group was 43.5%, comparison between them showed significant difference (P<0.01). (2) Morphological examination of endometrial tissue showed the inflammation in the treated group abated after treatment with the contractible function of helicine artery strengthened. Experimental study showed: (1) The auricular swelling of mice was inhibited by 40.5% in the treated group, the effect was equivalent to that of hydrocortisone (46.9%). (2) Compared with the control group, the plasma 6-keto-PGF1alpha and D-Dimer level in the treated group were markedly lower, and TXB2/6-keto-PGF1alpha ratio and plasma endothelin level were markedly higher (P<0.05 or P<0.01). ET contents in large dosage TCM group was significantly raised (P<0.05). (3) XYZXC could increase amplitude of contraction of the uterus smooth muscle as well as the uterus activity in rats in vivo. CONCLUSION: XYZXC has obvious anti-inflammatory and hemostatic effects, it has marked effect in treating IUD caused pre- and post-menstruation menorrhagia, the possible mechanism may be: (1) Modulating the synthesis of prostaglandin; (2) Antagonizing the IUD caused fibrinolytic hyperfunction; (3) Promoting the synthesis of ET; (4) Increasing the contractility and activity of uterus smooth muscle.

Adult↗
PubMed1991

Fibrinolysis in idiopathic menorrhagia.

Serum fibrin/fibrinogen degradation product (FDP) was studied in 64 patients of menorrhagia without any organic cause in addition to 24 healthy women by Thrombo - Wellcotest HA - 13 Kit (Wellcome, England). Serum FDP levels were found to be less than 10 micrograms/ml in healthy subjects, whereas in idiopathic menorrhagia it was more than 10 micrograms/ml in 59.34% patients. Semi-quantitative estimation of FDP in 14 patients of idiopathic menorrhagia indicated a positive correlation between duration of bleeding and FDP levels. Bleeding appears to be due to increased fibrinolytic activity in uterus secondary to plasminogen activator. Such patients are likely to be benefitted with anti-fibrinolytic agents.

Female↗
PubMed1991

[Effect of shen-qian gu-jing granule on fibrin degradation products in serum and menstrual fluid of patients with menorrhagia].

Shen-Qian Gu-Jing granule was used in the treatment of the menorrhagia in 72 cases including idiopathic menorrhagia 28, uterine myoma 29, endometriosis 7, intrauterine device 5, postpartum and post induced abortion 3 cases. The amount of menstrual blood loss (MBL) and the fibrin degradation products (FDP) level in menstrual fluid and peripheral blood were measured before and after treatment. 87.5% of all cases showed a significant decrease in MBL (P less than 0.05). The local FDP level significantly decreased parallel to effectiveness of MBL. The results suggested that the function of this Chinese herbs complex in menorrhagia was related to the regulation of FDP level.

Adult↗
PubMed1990

Menorrhagia.

Excessive vaginal bleeding, or menorrhagia, is one of the most common presenting symptoms for gynecologic patients. Although this disorder has many possible etiologies, it is generally possible to approach its diagnosis and management in an orderly fashion. When evaluating the menorrhagic patient, it important to gear the work-up toward a differential diagnosis that includes pregnancy-related causes, hormonal problems, iatrogenic etiologies, mechanical intrauterine disorders, infections of the lower genital tract, and gynecologic cancers (PHIMIC). This differential approach can guide the types of historical data obtained from the patient, focus the physical examination, and alert the practitioner to the most appropriate laboratory and radiologic evaluation. Therapy can differ widely, depending on the cause of the bleeding. Most types of menorrhagia respond to medical therapy with oral contraceptives, oral synthetic estrogens or progestins, and long-acting intramuscular progestins or GnRH agonists. Surgical approaches, such as dilatation and curettage or hysterectomy, are less and less a first-line therapy; but innovative surgical techniques such as hysteroscopy and laparoscopic surgery are becoming increasingly important. With rapid, goal-directed diagnosis and specific therapy, the medical complications, anxiety, and discomfort suffered by the woman with menorrhagia can be alleviated quickly.

Female↗