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Risk-Benefit Assessment of Drugs Used for the Treatment of Menstrual Disorders

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  • Risk-Benefit Assessment
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Summary

This article considers the benign yet debilitating conditions of menorrhagia, dysmenorrhoea and irregular menstrual bleeding. Surprisingly little has been reported in the literature concerning these common ailments which can detract from the quality of female life during the reproduction years. Both dysmenorrhoea and menorrhagia are subjective complaints, but despite accurate means of measuring menstrual blood loss such quantification is rarely performed. This lack of diagnostic accuracy is a cause for concern, especially as both medical and surgical treatment are not without risk.

The therapeutic alternatives which are commonly prescribed in an attempt to rectify such menstrual disorders are discussed. These include the nonsteroidal anti-inflammatory agents, the combined oral contraceptives, danazol, progestogens, antifibrinolytics, haemostatics, luteinising hormone releasing hormone analogues and clomiphene. The results of clinical trials which have utilised these various agents are considered in terms of both the effectiveness of treatment and its potential adverse effects.

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References

  • Achiron A, Gornish M, Melamed E. Cerebral sinus thrombosis as a potential hazard of antifibrinolytic treatment in menorrhagia. Stroke 21: 817–819, 1990

    Article  PubMed  CAS  Google Scholar 

  • Agnelli G, Gresele P, De Cunto M, Gallai V, Nenci G. Tranexamic acid, IUCD and fatal cerebral arterial thrombosis. British Journal of Obstetrics and Gynaecology 89: 681–682, 1982

    Article  PubMed  CAS  Google Scholar 

  • Andersch B, Milsom I, Rybo G. An objective evaluation of flurbiprofen and tranexamic acid in the treatment of idiopathic menorrhagia. Acta Obstetrica Gynecologica Scandinavica 67: 645–648, 1988

    Article  CAS  Google Scholar 

  • Bergqvist A, Rybo G. Treatment of menorrhagia with intrauterine release of progesterone. British Journal of Obstetrics and Gynaecology 90: 255–258, 1983

    Article  PubMed  CAS  Google Scholar 

  • Bishop PMF and de Almeida JC. Treatment of functional menstrual disorders with norethisterone. British Medical Journal 1: 1103–1105, 1960

    Article  PubMed  CAS  Google Scholar 

  • Bonnar J, Sheppard BL, Dockeray CJ. The haemostatic system and dysfunctional uterine bleeding. Research and Clinical Forums 5: 27–36, 1983

    Google Scholar 

  • Cameron IT, Haining RH, Lumsden MA, Thomas VR, Smith SK. The effects of mefenamic acid and norethisterone on measured menstrual blood loss. Obstetrics and Gynecology 76: 85–88, 1990

    PubMed  CAS  Google Scholar 

  • Cameron IT, Leask R, Kelly RW, Baird DT. The effects of danazol, mefenamic acid, norethisterone and a progesterone-impregnated coil on endometrial prostaglandin concentrations in women with menorrhagia. Prostaglandins 34: 99–110, 1987

    Article  PubMed  CAS  Google Scholar 

  • Chimbira TH, Anderson AB, Cope E, Turnbull AC. Effect of danazol on serum gonadotrophins and steroid hormone concentrations in women with menorrhagia. British Journal of Obstetrics and Gynaecology 87: 330–336, 1980b

    Article  PubMed  CAS  Google Scholar 

  • Chimbira TH, Anderson AB, Naish C, Cope E, Turnbull AC. Reduction of menstrual blood loss by danazol in unexplained menorrhagia: lack of effect of placebo. British Journal of Obstetrics and Gynaecology 87: 1152–1158, 1980a

    Article  PubMed  CAS  Google Scholar 

  • Chimbira TH, Anderson AB, Turnbull AC. Relation between measured menstrual blood loss and patient’s subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. British Journal of Obstetrics and Gynaecology 87: 603–609, 1980c

    Article  PubMed  CAS  Google Scholar 

  • Chimbira TH, Cope E, Anderson AB, Bolton FG. The effect of danazol on menorrhagia, coagulation mechanisms, haemato-logical indices and body weight. British Journal of Obstetrics and Gynaecology 86: 46–50, 1979

    Article  PubMed  CAS  Google Scholar 

  • Cole SK, Billewicz WZ, Thomson AM. Sources of variation in menstrual blood loss. Journal of Obstetrics and Gynaecology in the British Commonwealth 78: 933–939, 1971

    Article  CAS  Google Scholar 

  • Conyngham RB. Norethisterone in menorrhagia. New Zealand Medical Journal 64: 697–701, 1965

    Google Scholar 

  • Coulter A, McPherson K, Vessey M. Do British women undergo too many or too few hysterectomies?. Social Sciences and Medicine 27: 987–994, 1988

    Article  CAS  Google Scholar 

  • Dockeray CJ. The medical treatment of menorrhagia. In Chamberlain (Ed.) Contemporary obstetrics and gynaecology, pp. 299–314, Butterworths, London, 1988

    Google Scholar 

  • Dockeray CJ, Sheppard BL, Bonnar J. Comparison between mefenamic acid and danazol in the treatment of established menorrhagia. British Journal of Obstetrics and Gynaecology 96: 840–844, 1989

    Article  PubMed  CAS  Google Scholar 

  • Foss GL. Clinical experience with norethisterone and norethisterone acetate. British Medical Journal 2: 1187–1191, 1960

    Article  PubMed  CAS  Google Scholar 

  • Fraser IS. The treatment of menorrhagia with mefenamic acid. Research and Clinical Forums 5: 93–99, 1983

    CAS  Google Scholar 

  • Fraser IS. Treatment of dysfunctional uterine bleeding with danazol. Australia and New Zealand Journal of Obstetrics and Gynaecology 25: 224–226, 1985

    Article  CAS  Google Scholar 

  • Fraser IS, McCarron G, Markham R. A preliminary study of factors influencing perception of menstrual blood loss volume. American Journal of Obstetrics and Gynecology 149: 788–793, 1984

    PubMed  CAS  Google Scholar 

  • Fraser IS, McCarron G, Markham R, Robinson M, Smyth E. Long-term treatment of menorrhagia with mefenamic acid. Obstetrics and Gynecology 61: 109–112, 1983

    PubMed  CAS  Google Scholar 

  • Fraser IS, Pearse C, Shearman RP, Elliott PM, McIlveen J, et al. Efficacy of mefenamic acid in patients with a complaint of menorrhagia. Obstetrics and Gynecology 58: 543–551, 1981

    PubMed  CAS  Google Scholar 

  • Grant JM, Hussein IY. An audit of abdominal hysterectomy over a decade in a district hospital. British Journal of Obstetrics and Gynaecology 91: 73–77, 1984

    Article  PubMed  CAS  Google Scholar 

  • Hagenfeldt K. The role of prostaglandins and allied substances in uterine haemostasis. Contraception 36: 23–35, 1987

    Article  PubMed  CAS  Google Scholar 

  • Hallberg L, Hogdahl AM, Nilsson L, Rybo G. Menstrual blood loss, a population study. Acta Obstetrica et Gynecologica Scan-dinavica 45: 320–351, 1966

    Article  CAS  Google Scholar 

  • Hallberg L, Nilsson L. Determination of menstrual blood loss. Scandinavian Journal of Clinical and Laboratory Investigation 16: 244–248, 1964

    Article  PubMed  CAS  Google Scholar 

  • Harrison RF, Campbell S. A double-blind trial of ethamsylate in the treatment of primary and intrauterine-device menorrhagia. Lancet 2: 283–285, 1976

    Article  PubMed  CAS  Google Scholar 

  • Haynes PJ, Flint AP, Hodgson H, Anderson AB, Dray F, et al. Studies in menorrhagia: (a) mefenamic acid, (b) endometrial prostaglandin concentrations. International Journal of Gynaecology and Obstetrics 17: 567–572, 1980

    PubMed  CAS  Google Scholar 

  • Jeppsson S, Mellquist P, Rannevik G. Short-term effects of dan-azol on endometrial histology. Acta Obstetrica et Gynecologica Scandinavica 123: (Suppl.) 41–44, 1984

    Article  CAS  Google Scholar 

  • Loffer FD. Hysteroscopy with selective endometrial sampling compared with D & C for abnormal uterine bleeding: the value of a negative hysteroscopic view. Obstetrics and Gynecology 73: 16–20, 1989

    PubMed  CAS  Google Scholar 

  • Lumsden MA. Dysmenorrhoea. In Baird & Michie (Eds) Mechanism of menstrual bleeding, pp. 195–213, Raven Press, New York, 1985

    Google Scholar 

  • MacKenzie IZ, Bibby JG. Critical assessment of dilatation and curettage in 1029 women. Lancet 2: 566–568, 1978

    Article  PubMed  CAS  Google Scholar 

  • Makarainen L, Ylikorkala D. Primary and myoma-associated menorrhagia: role of prostaglandins and effects of ibuprofen. British Journal of Obstetrics and Gynaecology 93: 974–978,1986

    Article  PubMed  CAS  Google Scholar 

  • Matta WH, Shaw RW, Hesp R, Evans R. Reversible trabecular bone density loss following induced hypo-oestrogenism with the LHRH analogue buserelin in premenopausal women. Clinical Endocrinology 29: 45–51, 1988

    Article  PubMed  CAS  Google Scholar 

  • Metcalf MG. Incidence of ovulatory cycles in women approaching the menopause. Journal of Biosocial Science 11: 39–48, 1979

    Article  PubMed  CAS  Google Scholar 

  • Mishell Jr DR. Noncontraceptive health benefits of oral steroidal contraceptives. American Journal of Obstetrics and Gynecology 142: 809–816, 1982

    PubMed  Google Scholar 

  • Nilsson L, Rybo G. Treatment of menorrhagia. American Journal of Obstetrics and Gynecology 110: 713–720, 1971

    PubMed  CAS  Google Scholar 

  • Rees MCP, Anderson AB, Demers LM, Turnbull AC. Prostaglandins in menstrual fluid in menorrhagia and dysmenorrhoea. British Journal of Obstetrics and Gynaecology 91: 673–680, 1984

    Article  PubMed  CAS  Google Scholar 

  • Rees MCP, Canete-Soler R, Lopez Bernai A, Turnbull AC. Effects of fenamates on prostaglandin E receptor binding. Lancet 2: 541–542, 1988

    Article  PubMed  CAS  Google Scholar 

  • Rees MCP, Di Marzo V, Tippins JR, Morris HR, Turnbull AC. Leukotriene release by endometrium and myometrium throughout the menstrual cycle in dysmenorrhoea and menorrhagia. Journal of Endocrinology 113: 291–295, 1987

    Article  PubMed  CAS  Google Scholar 

  • Shaw RW, Fraser HM. Use of a superactive luteinizing hormone releasing hormone (LHRH) agonist in the treatment of menorrhagia. British Journal of Obstetrics and Gynaecology 91: 913–916, 1984

    Article  PubMed  CAS  Google Scholar 

  • Smith SK, Abel MH, Kelly RW, Baird DT. Prostaglandin synthesis in the endometrium of women with ovular dysfunctional uterine bleeding. British Journal of Obstetrics and Gynaecology 88: 434–442, 1981

    Article  PubMed  CAS  Google Scholar 

  • Tauber PF, Kloppel A, Goodpasture JC, Burns J, Ludwig H, et al. Reduced menstrual blood loss by release of an antifibrolytic agent from intrauterine contraceptive devices. American Journal of Obstetrics and Gynaecology 140: 322–328, 1981

    CAS  Google Scholar 

  • Thiery M, Van der Pas H, Delbarge W, Van Kets H. The levonorgestrel intrauterine device. Geburtshilfe und Frauenheilk-und 49: 186–188, 1898

    Article  Google Scholar 

  • Treolar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. International Journal of Fertility 12: 77–126, 1967

    Google Scholar 

  • Vargyas JM, Campeau JD, Mishell Jr DR. Treatment of menorrhagia with meclofenamate sodium. American Journal of Obstetrics and Gynecology 157: 944–950, 1987

    PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Academic Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London, NW3 20G, England

    Jennifer M. Higham &  Robert W. Shaw

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  1. Jennifer M. Higham
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  2. Robert W. Shaw
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Higham, J.M., Shaw, R.W. Risk-Benefit Assessment of Drugs Used for the Treatment of Menstrual Disorders. Drug-Safety 6, 183–191 (1991). https://doi.org/10.2165/00002018-199106030-00004

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  • DOI: https://doi.org/10.2165/00002018-199106030-00004

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