ASSESSMENT OF MEDICAL TREATMENTS FOR MENORRHAGIA

Although usually not life-threatening, dysfunctional uterine bleeding (DUB) can cause discomfort and disruption to life for many women. It has been poorly researched in the past, primarily because of difficulties in trying to accurately measure blood loss and response to treatment. There are several different therapies currently available but, for many, actual evidence of their efficacy is lacking from scientific data. Progestogens are the most frequently prescribed drugs for the treatment of DUB. Data support their use in anovulatory women but a number of comparative trials have shown that an overall reduction in blood loss of only 20% is achieved in ovulatory women. Their use, therefore, must be questioned as the first line of treatment. Combined oral contraceptives were at one time popular but whether the low-dose, current generation pills are equally effective awaits appropriate trials. Prostaglandin synthetase inhibitors can be useful, with up to a third of women with menorrhagia benefiting from a reduction of between 25% and 35% in blood loss. A proportionally greater reduction is seen in women with more excessive bleeding. Antifibrinolytic drugs have been shown to reduce menstrual blood loss in DUB by 50% and would be useful in women in whom oestrogens are contraindicated. Gonadotrophin-releasing hormone analogues are highly effective because of their ability to induce amenorrhoea, but longterm use is contraindicated because of their hypo-oestrogenic effects. One other effective therapy for menorrhagia has been danazol. At a dosage of 200 mg daily, danazol has been shown to be highly effective in several open and randomised comparative trials, with a consistent reduction of blood loss of up to 75% being achieved with maintenance of a regular menstrual cycle. Reducing the dose to 100 mg daily often results in cycle irregularities, whereas increasing the dose to 400 mg daily induces amenorrhoea. A daily dose of 200 mg of danazol is well tolerated and should be considered as a first-line option in DUB presenting as menorrhagia requiring medical management.