Drugs for treatment of menorrhagia – Gynaecology MCQ

The use of which of the following drugs for the treatment of menorrhagia is not supported by clinical evidence?
A. Tranexamic acid
B. Oral contraceptives
C. Ethamsylate
D. Progesterone only pills

Correct answer : C. Ethamsylate

Studies have failed to prove the effectiveness of ethamsylate in the treatment of menorrhagia.

Drugs used for the treatment of menorrhagia

Non hormonal agents

  • Nonsteroidal antiinflammatory drugs
    • They are the first line treatment in ovulatory menorrhagia
    • Studies have demonstrated a 20-46% reduction in menstrual blood flow
  • Antifibrinolytics
    • Prevent fibrinolysis and breakdown of clots
    • eg: Tranexamic acid, Epsilon amino caproic acid
  • Ethamsylate

Hormonal agents

  • Progesterone therapy
    • They prevent endometrial proliferation
    • eg: Norethisterone, Medroxyprogesterone acetate, Dydrogesterone

MIRENA Levonorgestrel IUDMIRENA Levonorgestrel IUD

  • IUD’s which release progesterone
    • They reduce menstrual blood flow by as much as 97% (after 12 months of use) and are as effective as hysteroscopic endometrial ablation
    • eg: MIRENA, Progestasert
  • Combined estrogen and progesterone pills
    • Used if the woman does not desire to become pregnant
    • They are more effective than using estrogen / progesterone alone
    • They decrease blood loss by 50% and prevent dysmenorrhoea
    • Side effects include breakthrough bleeding, nausea, breast tenderness and weight gain
  •  Danazol
    • It is a synthetic ethisterone derivative that has weak androgenic, anabolic and progestational action
    • It inhibits pituitary secretion of gonadotropins and inhibits steroidogenic enzymes
    • It reduces menstrual blood loss
    • Complete amenorrhoea can occur with higher doses
    • It can cause androgenic side effects like acne, hirsutism and decreased breast size
  • GNRH agonists
    • They are expensive and are used only when other drugs fail to provide relief
    • They inhibit pituitary release of FSH and LH
    • They can cause menopausal symptoms and osteoporosis

Ref:

  • Essentials of Medical Pharmacology, K D Tripathi, 7th ed
  • Shaw’s Textbook of Gynaecology, 14th ed
  • Andersson JK, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gynaecol. Aug 1990;97(8):690-4.
  • Menorrhagia Treatment & Management, Julia A Shaw, MD, MBA, FACOG; Chief Editor: Michel E Rivlin, MD, emedicine.medscape.com

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