Medical management of menorrhagia

摘要

Menorrhagia is a common complaint and accounts for 12% of referrals to gynaecology clinics. Prevalence increases with age and peaks just prior to menopause.It has been estimated that the treatment of menorrhagia accounts for up to 1% of all healthcare costs.Effective medical treatments do exist, but clinicians are poor prescribers of the most effective treatments.The main classes of drugs employed for the medical treatment of menorrhagia are non-hormonal (inhibitors of prostaglandin synthesis, antifibrinolytic agents and haemostatic agents) and hormonal therapies.First-line management of menorrhagia consists of prostaglandin inhibitors, antifibrinolytic agents, oral contraceptive pill, high dose progestogens and progesterone intra-uterine systems, which can reduce menstrual blood loss by 25%, 50%, 50%, 85% and 90%, respectively. Second-line treatment consists of danazol and GnRH agonists which reduce menstrual loss by 50% and 100%. These treatments are second line as these use is limited by side-effects and or limited duration of use.