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PubMed1986

Measured menstrual blood loss in women with menorrhagia associated with pelvic disease or coagulation disorder.

Fifty-five women with a convincing clinical history of menorrhagia associated with recognizable pelvic disease (40 women) or a confirmed coagulation disorder (15 women) were studied through one or more cycles with measurements of menstrual blood loss volume by a modified alkaline hematin method. Women with leiomyomata almost always exhibited large volumes of menstrual bleeding, which was invariably reduced by myomectomy and sometimes helped by mefenamic acid. Women with other pelvic disease such as endometriosis, adenomyosis, and myometrial hyperplasia also often exhibited genuine menorrhagia that responded to mefenamic acid, whereas others were found to have normal blood loss even when the history was convincing. Some women with coagulation disorders due to platelet dysfunction exhibited gross menorrhagia but others had blood loss within normal limits.

Blood Coagulation Disorders↗
PubMed1983

The outcome of menorrhagia: a retrospective case control study.

One hundred and three women who were known to have complained of menorrhagia at some time in their lives were compared with a control group drawn from the practice's age-sex index.The results indicated that the women in the menorrhagia group were more likely to have had antidepressant medication prescribed for them at some time in their lives than the women in the control group. Furthermore, their case folders were thicker than those of the controls. The age at which menorrhagia was first reported was the only factor studied which was associated with increased likelihood of hysterectomy.

Adolescent↗
PubMed1995

Menorrhagia management options.

A prospective study of the management of menorrhagia in new patients presenting to gynaecological outpatients was undertaken at four centres in Northern Ireland and two in Great Britain. 325 patients were enrolled, the majority of whom (87%) had severe menorrhagia. Patients in all six centres were similar in relation to age, marital status, parity, use of contraception and severity of symptoms. 62% of the patients were managed medically, improved and were discharged. The rates of surgical intervention, in particular in women aged less than 40, appeared higher in the Northern Ireland hospitals than Great Britain. There is a need to review and audit current practices in the management of menorrhagia.

Adolescent↗
PubMed1995

Treatment of menorrhagia.

The treatment of menorrhagia has changed significantly in two ways. Between 20% to 40% of women complaining of menorrhagia have normal to below normal blood loss and may avoid medical and surgical treatment by learning how to cope with menstrual loss. Ninety per cent of women with menorrhagia not responding to drug therapy can be treated by a wide variety of endoscopic procedures and hysterectomy is required for only a few of these patients. This article reviews the subject with emphasis on current practice and new endoscopic procedures.

Endometriosis↗
PubMed1994

[The efficacy of the hysteroscopic treatment of menorrhagia associated with uterine fibromyomas].

Objective of our study was to determine the effectiveness of hysteroscopic surgery in the treatment of menorrhagia associated with uterine myomas. 25 women with clinical and ultrasonographic diagnosis of intramural or submucous myomas were treated for menorrhagia by hysteroscopic surgery: 9 by resection and 16 by resection and endometrial ablation. In both groups there was a significant decrease of dysmenorrhea. The mean number of pads used during the heaviest day of menses decreased significantly from 19.5 to 7.4 in women undergoing resection only, and from 20.8 to 2.9 in women treated by resection and endometrial ablation. 2 women of 9 became amenorrheic and no one underwent hysterectomy. 12 of 16 became amenorrheic and 2 underwent hysterectomy. Our study show that menorrhagia can be treated by hysteroscopic surgery of uterine myomas in some selected women.

Adult↗
PubMed1993

Hysteroscopic treatment of menorrhagia associated with uterine leiomyomas.

OBJECTIVE: To determine the effectiveness of hysteroscopic treatment of menorrhagia associated with uterine leiomyomas. METHODS: Fifty-one women with uterine myomas were treated for menorrhagia by hysteroscopic resection with or without endometrial ablation. Patients were followed for 1-5 years after treatment. RESULTS: The mean number of pads used during the heaviest day of menses decreased from 17.8 before treatment to 6.8 after treatment (P < .005) in women undergoing resection only, and from 21.4 to 1.7 pads per day in women whose treatment included endometrial ablation (P < .001). Two-thirds of the women who underwent ablation were completely amenorrheic after the procedure. Both groups experienced significant decreases in dysmenorrhea. Three patients subsequently underwent hysterectomy after hysteroscopic treatment, and one required a repeat hysteroscopic procedure. CONCLUSION: Hysteroscopic treatment of menorrhagia associated with uterine myomas can be effective in carefully selected patients.

Adult↗
PubMed1977

Vitamin A in the treatment of menorrhagia.

Hypovitaminosis A was found to be an important cause of menorrhagia, and a statistically significant difference between the fasting serum vitamin A values of healthy controls and patients with menorrhagia was noted. Vitamin A is a co-factor of 3 beta-dehydrogenase in steroidogenesis and deficiencies of this vitamin may result in impaired enzyme activity. The level of endogenous 17 beta-oestradiol appears to be elevated with vitamin A therapy, and menorrhagia was alleviated in more than 92% of patients.

Adolescent↗
PubMed1996

Treatment of menorrhagia due to dysfunctional uterine bleeding.

Menorrhagia due to dysfunctional uterine bleeding can be treated medically or surgically. Medical therapy is associated with less morbidity and less profound effects on body image and fertility. Nonsteroidal anti-inflammatory drugs are the agents of choice for menorrhagia, although oral contraceptives, danazol and newer hormonal agents may also be used. Hysterectomy has been the surgical procedure traditionally used to treat menorrhagia, but excisional or "rollerball" endometrial resection may improve or cure this problem with a shorter hospital stay, a lower cost and less morbidity.

Algorithms↗
PubMed1996

Endometrial ablation for severe menorrhagia in a patient with hereditary hemorrhagic Telangiectasia. A case report.

BACKGROUND: Hereditary hemorrhagic telangiectasia is a rare, inherited disease characterized by abnormal visceral and superficial blood vessel anastomoses. These telangiectasias predispose the patient to a lifelong history of recurrent bleeding for the nasal and gastrointestinal mucosa. Less commonly involved organs include the liver, brain and lung. To date there is no cure for this disease. Management requires many palliative minor surgical procedures to stop actively bleeding sites. Major surgery is often contraindicated in these patients due do coexisting medical sequelae of their underlying disease. CASE: Menorrhagia was diagnosed in a 42 year-old multipara with known history of hereditary hemorrhagic telangiectasia. The bleeding was unresponsive to hormonal therapy. Substantial preexisting conditions, including profound anemia, history of multiple strokes, a seizure disorder and ventricular arrhythmias, precluded major surgical intervention, including hysterectomy. Serial injections of leuprolide acetate injections were followed by hysteroscopic "rollerball" electrocoagulation of the endometrium under regional anesthesia. On long-term follow up, the patient was cured of her menorrhagia. CONCLUSION: Endometrial ablation provides patients who have significant medical complications with an effective, minimally invasive alternative to hysterectomy for control of menorrhagia.

Adult↗
PubMed1997

[Analysis of the outcomes of transcervical resection of endometrium in 400 cases with menorrhagia].

OBJECTIVE: To report the efficacy and outcomes of transcervical resection of the endometrium (TCRE) in treatment of menorrhagia. METHODS: 400 patients with menorrhagia due to fatigue causes who had failed in medical therapy and did not desire pregnancy and surgery underwent TCRE under hysteroresectoscope. Among them, 72 patients with submucous uterine myoma less than 5cm in diameter had their myoma resected simultaneously, 366 cases were followed up postoperatively for 3 months to 4 years. RESULTS: TCRE was performed successfully except 16 cases, giving a success rate of 95.6%. Three cases sustained uterine perforation. During follow-up, 146 cases (41.7%) became amenorrhea, 119 (34.0%) had only spotting. The remaining 85 (24.3%) had normal periods. 78.3% of the cases who previously had dysmenorrhea had relieved their pain. Long-term complications were recurrent abnormal uterine bleeding (22 cases 13 of them had a second operation), hematometra (5) and adenomyosis (4 cases). CONCLUSION: TCRE is an effective procedure in treating menorrhagia and small submucous uterine myoma.

Adult↗
PubMed1996

Concomitant Laparoscopic Surgery and Hysteroscopic Endometrial Ablation for Women with Chronic Pelvic Pain and Menorrhagia

From September 1993 to July 1995, 63 women (mean age 38 yrs, range 26-53 yrs, parity 0-7) with chronic pelvic pain (CPP) and menorrhagia underwent outpatient laparoscopic surgery and endometrial ablation. Operating time ranged from 9 to 110 minutes (mean 52 min). Laparoscopic procedures included excision of endometriosis (26), adhesiolysis (17), electromyolysis (4), uterine suspension (6), and appendectomy (4). At 6 to 20 months' follow-up 63 women reported no pain (24, 38.1%), significant improvement of pain (25, 39.7%), no change in amount of pain (9, 14.3%), and an increase of pain (5, 7.9%). Six patients had repeat laparoscopy. After hysteroscopic endometrial rollerball ablation and resection, the same women reported amenorrhea (31, 49.2%), hypomenorrhea (26, 41.3%), eumenorrhea (3, 4.8%), and no change in menstrual bleeding (3, 4.8%). Two women had a repeat endometrial ablation and one had hysterectomy for menorrhagia and CPP. Concomitant laparoscopic surgery and endometrial ablation is an effective alternative to hysterectomy for women with CPP and menorrhagia.

Journal Article↗
PubMed1996

Economic Evaluation of Hysteroscopic Endometrial Ablation versus Vaginal Hysterectomy for Menorrhagia

Between June 1992 and July 1993, 40 women with menorrhagia underwent vaginal hysterectomy, performed by 5 surgeons in one hospital. The patients were retrospectively compared with the first 40 women having endometrial ablation for menorrhagia performed during the same period by senior author. The age, parity, weight, and uterine size were similar in both groups. Measurable costs were surgical time, procedure time (anesthetist and resource use in operating room), length of hospital stay, convalescence (value of patient time), and indirect costs associated with subsequent surgical procedures. Measurable benefits were estimated blood loss, complications, and effectiveness of the procedure. The total cost per episode of care was estimated to be $5373 and $2279 (1995 $ Canadian) for vaginal hysterectomy and hysteroscopic endometrial ablation, respectively, for a mean saving of $3094. The benefits derived from both procedures were comparable. Vaginal hysterectomy eliminated bleeding in 100% of women and was associated with a complication rate of 41%. Endometrial ablation eliminated or improved bleeding in 90% of women (amenorrhea 46%, hypomenorrhea 35%, eumenorrhea 9%, no significant change 10%), was associated with no complications, and resulted in 82% satisfaction. Endometrial ablation is 82% effective and 58% less expensive than vaginal hysterectomy for the treatment of women with menorrhagia.

Journal Article↗
PubMed1997

Treatment Decisions in the Management of Menorrhagia.

Menorrhagia--menstrual periods lasting longer than 7 days and totaling blood losses greater than 80mL--affects 9%-14% of otherwise healthy women, and it can signal cancer, an endocrinologic disorder, or gynecologic disease. Blood loss can be high enough to result in anemia, fatigue, and syncope. Most often, abnormal uterine bleeding such as menorrhagia involves a disruption in the hypothalamic-pituitary axis, the ovary, and/or the uterus. Other identified causes include medications (especially psychotropics) that cross the blood-brain barrier; chronic diseases such as cancer, diabetes, and liver and kidney dysfunction; endocrine disorders, perimenopausal anovulation, polycystic ovary disease, pituitary tumors, and abnormal estrogen cycling caused by morbid obesity; and anatomic abnormalities of the uterus. Routine tests include hematocrit or hemoglobin to detect and evaluate anemia, thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause, and a pregnancy test to rule out an incomplete, spontaneous abortion as a cause. A Pap test is recommended to screen for dysplasia that can suggest a gynecologic cancer cause. Additional screening for endocrine disorders that may be causing menorrhagia include tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels. Treatment can be medical or surgical. Medical treatment includes prostaglandin inhibitors, specifically nonsteroidal antiinflammatory drugs (NSAIDs), and hormonal therapy with estrogen, progesterone, gonadotropin-releasing hormone agonists, or oral contraceptives such as medroxyprogesterone (Depo-Provera). Surgical treatment includes hysteroscopic endometrial ablation by physical agents, laser electrodiathermy, and "roller ball," or surgical, resection. Hysterectomy is the treatment of last resort.

Journal Article↗
PubMed1995

Levonorgestrel intrauterine device in the treatment of menorrhagia in Chinese women: efficacy versus acceptability.

Ten Chinese women who had menorrhagia without organic cause and suffered from anaemia were treated with levonorgestrel intrauterine device for a total of 129 woman-months. There was a 54%, 87% and 95% reduction in menstrual blood loss at the first, third and sixth month of treatment when compared with the pretreatment cycle. These percentages of reduction were statistically significant, with p values of 0.004, 0.03 and 0.008, respectively. There was a median increase in menstrual cycle length of 12 days in nine months. Fifteen percent of the menstrual cycles were longer than 60 days. The total bleeding days increased by 4 days at the third menstrual cycles, but reduced to a median of 6 days at 6 months. Seventy-six percent of the menstrual bleeding was in the form of spotting. These Chinese women accepted such menstrual alterations. There was no hormonal side effects. All women preferred the device to hysterectomy. Levonorgestrel intrauterine device appeared to be an effective and acceptable treatment for menorrhagia in perimenopausal Chinese women.

Adult↗
PubMedDate not supplied

Studies in menorrhagia: (a) mefenamic acid, (b) endometrial prostaglandin concentrations.

Twenty-two women with unexplained heavy menstrual blood loss (average loss for two cycles of >80 ml) were treated with the prostaglandin synthetase inhibitor menfenamic acid during two consecutive menstruations. There was a significant reduction in menstrual blood loss on mefenamic acid therapy, the median loss being 137 ml before treatment and 76 ml while on treatment. Reduction in menstrual loss was achieved in 20 of the 22 patients but varied from a 2% to 78% reduction. The greater the menstrual loss before treatment, the more it was reduced on mefenamic acid therapy. Endometrial concentrations of prostaglandins E2 and F2 alpha in the follicular phase of the cycle were similar whether or not patients had menorrhagia. In the luteal phase, however, 6 of 14 patients with menorrhagia had higher endometrial prostaglandin E2 and F2 alpha concentrations than all 13 controls.

Adolescent↗
PubMed1994

The morphologic changes of endometrial spiral arterioles in IUD-induced menorrhagia.

To investigate the relationship between IUD-induced menorrhagia and spiral arteriolar function, we examined the endometrium under light and electron microscope on samples obtained within 24 hours after the onset of premenstrual spotting. These samples included an IUD bleeding group (20 cases), an IUD non-bleeding group (20 cases) and an IUD non-user group (10 cases) as controls. Compared with the IUD non-user group the degenerative changes of spiral arteriolar wall were more severe and dilation of the spiral arteriolar lumen was more obvious, especially in the spongeous layer. In the IUD non-user group these changes were mild, suggesting that IUD-induced menorrhagia might be correlated with poor contractility of spiral arterioles in the spongeous layer.

Adult↗
PubMed1992

The possible relationship between menorrhagia and occult hypothyroidism in IUD-wearing women.

A high incidence of occult hypothyroidism in menorrhagic women has been reported and emphasized in recent studies. In order to verify this statement, we have evaluated the functional status of the thyroid gland in intrauterine device (IUD) wearers suffering from increased menstrual bleeding. The study group consisted of 40 IUD-wearing women, aged 26-46 years, suffering from metrorrhagia. The control group consisted of 38 IUD-fitted women, 22-44 years old, in whom menstrual bleeding was not significantly increased. Menorrhagia was defined as excessive vaginal bleeding lasting for 6 days or more, and/or containing a significant amount of blood clots. Free thyroxine (FT) and thyroid-stimulating hormone (TSH) levels were assessed. FT levels were identical in both groups and within the normal range (1.31 +/- 0.28 ng/dl). TSH levels were significantly higher in the study group than in the controls, although they remained within the normal range (2.75 +/- 2.06 vs. 1.45 +/- 0.45 microU/ml, p < 0.01). A thyrotropin-releasing hormone (TRH) test was performed in 10 women having the highest TSH levels. All the results of TRH tests were consistent with occult hypothyroidism. These women were treated with L-thyroxine and all had a significant improvement in their bleeding within 3 months of treatment. We concluded that any IUD-wearing woman suffering from menorrhagia may have occult hypothyroidism. Should FT and TSH be within normal limits, a TRH test should be performed as the definitive diagnostic test. A frequent side-effect of intrauterine contraception is menometrorrhagia. The intrauterine device (IUD) has to be removed in 5-15% of cases to prevent iron deficiency anemia.

Adult↗
PubMed1993

A comparative study of danazol, a regimen of decreasing doses of danazol, and norethindrone in the treatment of objectively proven unexplained menorrhagia.

OBJECTIVE: Our purpose was to compare the efficacy of the recommended dose of danazol, a reduced-dose danazol regimen, and norethindrone in the treatment of objectively proven menorrhagia. Recurrence after discontinuing treatment was also assessed. STUDY DESIGN: The study was a single-blind, randomized, parallel, comparative study. After a placebo run-in period over two menstrual cycles, 57 patients with a baseline mean menstrual blood loss of at least 80 ml per cycle were randomly assigned to receive one of three therapies: danazol, 200 mg/day (n = 19) for three menstrual cycles; danazol, 200 mg/day for one cycle, 100 mg/day for one cycle, and 50 mg/day for one cycle (n = 19); and norethindrone, 5 mg three times daily on days 19 through 26 of the cycle for three consecutive cycles (n = 19). Patients in whom treatment was successful (those experiencing blood loss < 80 ml) were entered in the follow-up phase of the study, receiving placebo for a maximum of four menstrual cycles. RESULTS: The final menstrual blood loss on treatment was significantly less for those patients who received both danazol regimens compared with those who received norethindrone (p = 0.017 for reducing dose danazol vs norethindrone and p = 0.043 for 200 mg of danazol vs norethindrone). Both danazol treatment regimens were significantly more successful in reducing menstrual blood loss to within the normal range than was norethindrone. The reducing-dose danazol regimen was successful in eight of 17 patients (p = 0.027), and 200 mg of danazol was successful in nine of 19 patients (p = 0.029), compared with the two successes of 18 patients treated with norethindrone. Significantly more recipients of 200 mg of danazol than of norethindrone subjectively rated their treatment to be moderately or highly effective (p = 0.033). Both danazol treatment regimens were associated with a higher incidence of adverse events than was norethindrone therapy, although the number of withdrawals were similar and infrequent in the three groups. CONCLUSIONS: Both danazol regimens were significantly more effective than norethindrone in reducing the excessive menstrual blood loss of women with unexplained menorrhagia. A subjective assessment by patients found that only the 200 mg of danazol was judged to be significantly more effective than norethindrone in controlling the heaviness of menstrual bleeding. The reduced-dose danazol regimen did not appear to markedly diminish the incidence of adverse events compared with the 200 mg of danazol regimen.

Adult↗