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