Menorrhagia – current management option
Menorrhagia or excessive uterine bleeding affects 20-30 % of women in reproductive age group. Most of the cases are due to dysfunctional uterine bleeding (d.u.b.) which implies no pelvic or extrapelvic pathology found.treatment options are :
1. medical treatment
: mainstay of treatment in DUB. Includes-
a. mefenamic acid : reduces blood loss by 20-30%
b.antifibrinolytic tranexmic acid: reduces blood loss by 50 %
c.progestagens: cyclical or continuous therapy , successful in anovulatory cases.
d.combined oral contraceptive pills: : reduces blood loss by 40%
e.GnRH analogue & danazol: although reduces blood loss effectively but not used because of side effect( menopausal , androgenic)
Disadvantage: side effect, non compliance, return of symptoms on stoppage of treatment.
2. Surgical treatment
: on failure of medical treatment,in elderly patients, not desirous of childbearing “hysterectomy”is indicated.
Disadvantages: physical social and emotional consequences besides the risk of minor and major complications related to surgery and anesthesia.
3. Endometrial ablation:
less invasive surgical procedure, good for women with no intrauterine pathology.
Procedure: only endometrial lining is destroyed while preserving the uterus.
Advantage: as compared to medical treatment better in terms of efficacy, patients satisfaction and improvement in quality of life.