Medical management of menstrual disorders

Abstract

A vast majority of women experience menstrual disorders some time in their life. Complaints of excessive menstrual loss, in particular, have a substantial impact on gynecological services. It is estimated that 5% of women consult their physician with menstrual problems each year, and up to 30% of reproductive age women suffer from menorrhagia. Menorrhagia is defined as blood loss of more than 80 ml per cycle, but already lower amounts may result in iron-deficient anemia. Before starting the medication for heavy menstrual bleeding, the possible organic cause should be assessed, and the age, pregnancy desires, general health and patient preference should be considered. The combined oral contraceptive pills (COCPs), prostaglandin inhibitors and tranexamic acid are still recommended as the first line of therapy for menorrhagia, especially in nulliparous women. All of these also have the added advantage of relieving dysmenorrhea. Other drugs, such as danazol and gonadotropin-releasing hormone agonists (GnRHa), reduce menstrual blood loss effectively, but due to side effects, their use is limited to special cases. Luteal progestins are widely used for the treatment of heavy menstrual bleeding, but women with regular ovulatory cycles suffering from menorrhagia do not benefit from the treatment.