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