Therapy of menorrhagia during menstruation, urinary infections



Menorrhagia is profuse bleeding during menstruation, with blood loss over the normal rate of 150 ml. As a rule, this is due to the fact that the menstrual cycle is delayed for a long time, more than seven days. Often the cause is inflammation of the genital organs. This also includes such diseases as ovarian dysfunction, uterine fibroids, and even mental overwork can lead to menstrual disorders and cause menorrhagia. This disease occurs with a complication, iron deficiency anemia appears as a result of blood loss, and of course, activity and disability are reduced [2].

Key words: bleeding, menstruation, menorrhagia, hysterectomy.

Меноррагия — это обильное кровотечение во время менструации, с потерей крови свыше обычной нормы, которая составляет 150 мл. Как правило, это происходит из-за того, что менструальный цикл затягивается на длительное время, более семи дней. Нередко причиной становится воспаление половых органов. Сюда же стоит отнести такие заболевания, как дисфункция яичников, миома матки и даже психическое переутомление могут привести к нарушению менструального цикла и вызвать меноррагию. Это заболевание протекает с осложнением, вследствие потери крови появляется железодефицитная анемия, и конечно же, снижается активность и трудоспособность.

Ключевые слова: кровотечения, менструация, меноррагия, гистерэктомия.

The basic principle of differential diagnosis of different types of menorrhagia is to eliminate organic causes of bleeding, i.e. gynecological and extragenital. Treatment of menorrhagia is conducted in accordance with the etiology, degree of blood loss, the general state of the patient and aimed at correcting the identified organic pathology or restore normal menstrual cycle [3].

Menorrhagia is a widespread gynecological problem, about which in the UK about 5 % of women aged 30–49 years go to doctors. Excessive blood loss during menstruation is the main complaint in 15 % of all visits to gynecologists and is the cause of half of the 90 thousand hysterectomies carried out annually in England. In most cases, menorrhagia is not associated with any specific diseases of the pelvic organs, and therefore they are defined as dysfunctional uterine bleeding (DUB).

The mechanism of regulation of blood loss during menstruation is not clear enough. In the past decade, however, it has been found that with MQM there is an increase in endometrial fibrinolysis and the balance of prostaglandin is disturbed. In connection with these new approaches to the treatment of MQD have been developed. Thus, the therapeutic effect of antifibrinolytic drugs, in particular tranexamic acid, in uterine bleeding was revealed. Mefenamic acid (mefenamic acid), an inhibitor of prostaglandin synthesis, and the hemostatic agent ethamsylate have become quite widely used to combat excessive blood loss during menstruation. The authors of the publication conducted a comparative randomized study of the therapeutic efficacy of these drugs in women suffering from menorrhagia [1].

Results. The study included 76 women aged 35–46 years with MQD, the organic cause of which was excluded during a preliminary gynecological examination. The average volume of blood loss during menstruation, calculated from the three preceding the inclusion of menstrual periods in the study, was more than 80 ml. After obtaining the consent of the women to participate in the study, they were included in one of three randomized formed therapeutic groups.

The women of the 1st group received 500 mg of ethamylate (ES) every 6 hours, the 2nd group received mefenamic acid (MK) at a dose of 500 mg every 8 hours, the 3rd group received 1 mg transexamic acid (TC) every 6 h. In each group, therapy lasted 5 days, starting from the first day of menstruation. The study assessed the total blood loss during menstruation, the duration of bleeding, the subjective individual assessment of blood loss, the number of hygiene items consumed during menstruation, the presence of dysmenorrhea symptoms, and the frequency, nature, duration and severity of adverse events.

When comparing the three control menstrual periods before the start of therapy and the three periods on the background of therapy, no effect of EC on blood loss was found, while MC reduced it by 20 % and TC decreased by 54 %. It turned out, however, that if TK was able to almost completely normalize blood loss, reducing its volume to 75 ml, then when applying MC the blood loss, although it decreased, but still averaged 148 ml, 3 times the norm.

None of the drugs did not change the duration of menstrual bleeding, however, during the treatment of MK and TK, a statistically significant decrease in the number of hygiene products was recorded. 69 % of women taking TC, and 57 % of those receiving MC, reported a subjective reduction in blood loss during therapy. 44 % of those women who took ES also noted a reduction in blood loss, while 30 % of women in this therapeutic group believed that blood loss even increased.

In a small number of women, the use of drugs was accompanied by headache, dizziness and nausea, the frequency of occurrence of which increased slightly during therapy with MC and TC. Despite this, in a survey of women conducted at the end of the study, it turned out that 74 % of those taking MC and 77 % of those who received TC would like to continue using these drugs. On the contrary, 67 % of women who received ES were opposed to continuing to use it.

Findings. The authors of the publication believe that the data obtained may affect the generally accepted approaches to the therapy of MQD. So far, TC is used only in 5 % of patients with menorrhagia, and hormonal preparations are still the main treatment for them, of which norethisterone is the most common and 38 % of patients are prescribed. The widespread use of hormonal drugs is based on the misconception that menorrhagia is primarily associated with hormonal imbalances. Progestogen is really effective in cases when anovulatory DMKs appear, however, a number of studies have shown that 95 % of women with menorrhagia have a normal ovulatory cycle.

The lack of effective treatment strategies for menorrhagia ultimately leads to an increase in the number of hysterectomies. In this regard, noteworthy is the fact that in Scandinavia, where TC is widely used to treat uterine bleeding, the number of hysterectomies is 2 times lower than in the UK. The authors of the publication associate the existence of prejudice against TC with the fears of doctors that this drug can cause thromboembolism, however extensive studies conducted in Scandinavia have shown that the incidence of thromboembolism in women with TK does not differ from the frequency of spontaneously arising thromboembolism.

In conclusion, the authors emphasize that TK in a dose of 1 mg, taken every 6 to 8 hours during the first 3 days of menstruation, can halve blood loss and normalize it in most women. The authors believe that TC therapy should necessarily be carried out before making a final decision regarding the need for hysterectomy.

References:

1. Bonnar J, Sheppard BL. Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid. BMJ 1996; 313: 579–82.

2. https://www.allwomens.ru/19544-menorragiya-prichiny-simptomy-lechenie.html

3. https://cyberleninka.ru/article/n/menorragiya-est-li-puti-resheniya