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Monday, 18 November 2013

Menstrual Disorders -Menorrhagia - Treatments in Conventional medicine Perspective

Menorrhagia is defined as a condition of excessive bleeding in the menstruation phase of the menstrual cycle in the reproductive age of a woman leading to heavy blood loss that can interfere with the woman normal activities, as a result of disruption of normal hormonal regulation of periods or disorders of certain reproductive organs.
Treatments
I. Conventional medicine
A. Primary menorrhagia
A.1.Ethamsylate
In a study of A double-blind trial of ethamsylate in the treatment of primary and intrauterine-device menorrhagia by R F Harrison, S Cambell, researchers found that During ethamsylate treatment the mean menstrual blood-loss was reduced by 50% in patients with primary menorrhagia and by 19% in patients with an I.U.C.D. This difference between the two groups is probably accounted for by the differing values of initial blood-loss which was significantly higher in the group with primary menorrhagia.

A.2. Include those in the secondary menorrhagia with the recommendation of your doctor.

B. Secondary menorrhagia
B.1. Hormone treatments
1. Contraceptive pill
a. Low-dose combination birth control pills which contains low-dose synthetic forms of the hormones estrogen and progesterone may be use to treat amenorrhea by controlling the menstrual cycle or bring the period back.
b. Risks and side effects
b.1. Growth of fibroids
Growth of fibroid is caused high level of estrogen and progesterone. The intake of the pill increase the level of both hormones resulting in increase the risk of growth of fibroid.
b.2. Recurrent of menstrual symptoms
Some women stop taking the pill may see all the menstrual symptoms coming back.
b3. Blood clots
Estrogen in the pill may cause blood clots in the small vessels in the leg and the lung.
b.4. Stroke and heart diseases
Study shows that women who have higher natural estrogen levels may have a higher risk of stroke and heart diseases.
b.5. Depression and mood swing
At the beginning, it may cause abnormal fluctuations in estrogen and progesterone elevate both physical and psychological stress, eventually resulting in both depression and mood swing
b.6. Bleeding and spotting
Bleeding and spotting is normal for the first six months for women who begin with any oral contraceptive combination pill treatment.
b.7. Lost interest in sex
Some women may experience lower sexual desire
b.8. Nutritional deficiency
Oral contraceptive pill causes vitamin and mineral imbalances or deficiencies.
b.9. Etc.

2. Norethisterone (Progesterone only pill)
Norethisterone a progestogen and has been used used treat premenstrual syndrome, painful periods, abnormal heavy bleeding, irregular periods. In a study of A comparative study of danazol and norethisterone in dysfunctional uterine bleeding presenting as menorrhagia M. Bonduelle, J.J. Walker and A.A. Caldert, researcher found that Since this study was undertaken, a report of
objective measurement of blood loss in small groups of patients9 casts further doubt on the
efficacy ofnorethisterone, although it confirms that of danazol. Since norethisterone is very widely used, a detailed assessment of its efficacy and safety in comparison to danazol is overdue. Should such a study confirm the findings discussed here then danazol could usefully be employed as first line therapy in the management of dysfunctional uterine bleeding presenting as menorrhagia.

3. Danazol
Danazol is synthetic steroid ethisterone, a modified testosterone that is used to inhibit ovarian steroidogenesis resulting in decreased secretion of estradiol and may increase androgens. although it is a standard medicine in treating menorrhagia
According the study of Efficacy of vaginal danazol treatment in women with menorrhagia during fertile age by Luisi S, Razzi S, Lazzeri L, Bocchi C, Severi FM, Petraglia F., researchers concluded that vaginal danazol resulted in effective medical treatment in young women with menorrhagia, and, because of a lack of significant adverse effects, it may be proposed as an alternative treatment.

4. Contraceptive coil (Mirena)
a. It is a soft, flexible T-shaped (birth control) device placed inside the uterus by your doctor within 7 days after the start of your period with medication Mirena continuous release over a period of 5 years to prevent pregnancy and reduce symptoms of menorrhagia. According to the study of SAFETY AND EFFICACY OF MIRENA IN MENORRHAGIA : 10 YEARS RESULTS OF VUOKKO-STUDY by R. Hurskainen, researcher suggested The preliminary 10-year results of Vuokko study show that LNG-IUS is a good alternative option to hysterectomy in the treatment of menorrhagia. Although half of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the costs remain significantly lower than in hysterectomy group. The transition from menorrhagia to menopause seems to be well tolerated and associated with a favourable bleeding pattern.
b. Risks and side effects
b.1.Spotting between periods
b.2. Complete absence of menstrual flow
b.3. Decreased bleeding during periods
b.4. Prolonged bleeding during periods
b.5. Breast pain and tenderness
b.6. Etc.

B.2. Non-hormonal treatments
1. Cyklokapron (tranexamic acid )
The medication has been used widely to reduce short-term in people up to 50% with a certain type of bleeding disorder, including menorrhagia.
2. According to the article of Cyklokapron posted in Drug.com
Risks and Side effects of Cyklokapron Injection include
a. In patients with acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity
b. In patients with subarachnoid hemorrhage. Anecdotal experience indicates that cerebral edema and cerebral infarction may be caused by Cyklokapron in such patients.
c. In patients with active intravascular clotting.
d. In patients with hypersensitivity to tranexamic acid or any of the ingredients.

B.3. Non-steroidal anti-inflammatory drugs (NSAIDs)
1. Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs with analgesic and antipyretic, anti-inflammatory effects, including over counter medicine aspirin, ibuprofen, and naproxen. The medicine has been use to reduce blood loss (it has been shown to be effective in randomized controlled trials, reducing menstrual blood loss (MBL) by 29.0% (95% CI 27.9 to 30.2%). and menstrual cramps and pain for women with menorrhagia)
2. Risks and side effects
a. Stomach bleeding
b. Heart failure
c. Toxicity to the kidneys, ears, and stomach
d. Heart diseases
e. Some researchers advised that Taking more than one NSAID is risky.
f. Etc. 
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