Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-12T08:59:19.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Treating Menorrhagia in Primary Care: An Overview of Drug Trials and a Survey of Prescribing Practice

Published online by Cambridge University Press:  10 March 2009

Angela Coulter ,
Joanne Kelland ,
Viv Peto  and
Margaret C. P. Rees
Angela Coulter
Affiliation:
King's Fund Centre for Health Services Development and University, College London Medical School
Joanne Kelland
Affiliation:
University of Leeds
Viv Peto
Affiliation:
Radcliffe Infirmary
Margaret C. P. Rees
Affiliation:
John Radcliffe Hospital
Get access Rights & Permissions [Opens in a new window]

Abstract

Menorrhagia can be treated by drug therapy or surgery. General practitioners (GPs) can prescribe drugs to reduce menstrual blood loss as first-line treatment, referring patients for surgical treatment if drug therapy fails. This study examined the efficacy of drugs used to treat menorrhagia and surveyed British GPs to discover the extent to which they prescribed the most effective drugs for this condition. The results suggest that treatment of this condition in primary care falls short of desirable standards. A meta-analysis of randomized trials of drug therapy revealed wide differences in efficacy and side effects. The most effective drug (tranexamic acid) is little used by British GPs, whereas the least effective drug (norethisterone) is the most frequently prescribed.

Type
Special Section: The Rational Use of Therapeutic Drugs
Information
International Journal of Technology Assessment in Health Care , Volume 11 , Issue 3 , Summer 1995 , pp. 456 - 471
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Andersch, B., Milson, I., & Rybo, G.An objective evaluation of flurbiprofen and tranexamic acid in the treatment of idiopathic menorrhagia. Acta Obstethcia et Gynecologica Scandinavica, 1988, 67, 645–48.CrossRefGoogle ScholarPubMed
2.Bonnar, J. Seminar on dysfunctional uterine bleeding (unpublished). London: The Royal Society of Medicine, 1994.Google Scholar
3.Callender, S., Warner, G., & Cope, E.Treatment of menorrhagia with tranexamic acid: A double-blind trial. British Medical Journal, 1970, 4, 214–16.CrossRefGoogle ScholarPubMed
4.Cameron, I., Haining, R., Lumsden, M.-A., et al. The effects of mefenamic acid and norethisterone on measured menstrual blood loss. Obstetrics and Gynecology, 1990, 76, 85–88.Google ScholarPubMed
5.Cameron, I., Leask, R., Kelly, R., & Baird, D.The effects of danazol, mefenamic acid, norethisterone, and a progesterone-impregnated coil on endometrial prostaglandin concentrations in women with menorrhagia. Prostaglandins, 1987, 34, 99–110.CrossRefGoogle Scholar
6.Chamberlain, G., Freeman, R., Price, F., et al. A comparative study of ethamsylate and mefenamic acid in dysfunctional uterine bleeding. British Journal of Obstetrics and Gynaecology, 1991, 98, 707–11.CrossRefGoogle ScholarPubMed
7.Chimbira, T., Anderson, A., Naish, C., et al. Reduction of menstrual blood loss by danazol in unexplained menorrhagia: Lack of effect of placebo. British Journal of Obstetrics and Gynaecology, 1980, 87, 1152–58.CrossRefGoogle ScholarPubMed
8.Chimbira, T., Anderson, A., & Turnbull, A.Relation between measured menstrual blood loss and patient's subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. British Journal of Obstetrics and Gynaecology, 1980, 87, 603–09.CrossRefGoogle ScholarPubMed
9.Coulter, A., Klassen, A., MacKenzie, I., & McPherson, K.Diagnostic dilatation and curettage: Is it used appropriately? British Medical Journal, 1993, 306, 236–39.CrossRefGoogle ScholarPubMed
10.Coulter, A., Klassen, A., & McPherson, K. How many hysterectomies should purchasers buy? European Journal of Public Health, in press, 1995.CrossRefGoogle Scholar
11.Coulter, A., & McPherson, K.The hysterectomy debate. Quarterly Journal of Social Affairs, 1986, 2, 379–96.Google Scholar
12.Davis, A., Anderson, A., & Turnbull, A.Reduction by naproxen of excessive menstrual bleeding in women using intrauterine devices. Obstetrics and Gynecology, 1981, 57, 74–78.Google Scholar
13.Dockeray, C., Shephard, B., & Bonnar, J.Comparison between mefenamic acid and danazol in the treatment of established menorrhagia. British Journal of Obstetrics and Gynaecology, 1989, 96, 840–44.CrossRefGoogle ScholarPubMed
14.Fraser, I., & McCarron, G.Randomized trial of two hormonal and two prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Australian New Zealand Journal of Obstetrics and Gynaecology, 1991, 31, 66–70.CrossRefGoogle Scholar
15.Fraser, I., McCarron, G., & Markham, R.A preliminary study of factors influencing perception of menstrual blood loss volume. American Journal of Obstetrics, 1984, 149, 788–93.CrossRefGoogle ScholarPubMed
16.Fraser, I., Pearse, C., Shearman, R., et al. Efficacy of mefenamic acid in patients with a complaint of menorrhagia. Obstetrics and Gynecology, 1981, 58, 543–51.Google ScholarPubMed
17.Gallegos, A., Aznar, R., Merino, G., & Guizer, E.Intrauterine devices and menstrual blood loss: A comparative study of eight devices during the first six months of use. Contraception, 1978, 17, 153–61.CrossRefGoogle Scholar
18.Guillebaud, I., Anderson, A., & Turnball, A.Reduction by mefenamic acid of increased menstrual blood loss associated with intrauterine contraception. British Journal of Obstetrics and Gynaecology, 1978, 85, 53–62.CrossRefGoogle ScholarPubMed
19.Hall, P., MacLachlan, N., Thorn, N., et al. Control of menorrhagia by the cyclo-oxygenase inhibitors naproxan sodium and mefenamic acid. British Journal of Obstetrics and Gynaecology, 1987, 94, 554–58.CrossRefGoogle ScholarPubMed
20.Hallberg, L., Hogdahl, A., Nilsson, L., & Rybo, G.Menstrual blood loss: A population study. Acta Obstetrica Gynecologica Scandinavica, 1966, 45, 320–51.CrossRefGoogle ScholarPubMed
21.Hallberg, L., & Nilsson, L.Determination of menstrual blood loss. Scandinavian Journal of Clinical & Laboratory Investigation, 1964, 16, 244–48.CrossRefGoogle ScholarPubMed
22.Harrison, R., & Campbell, S.A double-blind trial by ethamsylate in the treatment of primary and intrauterine device menorrhagia. Lancet, 1976, ii, 283–85.CrossRefGoogle Scholar
23.Haynes, P., Anderson, A., & Turnbull, A.Patterns of menstrual blood loss in menorrhagia. Research and Clinical Forums, 1979, 1, 73–78.Google Scholar
24.Haynes, P., Hodgson, H., Anderson, A., & Turnbull, A.Measurement of menstrual blood loss in patients complaining of menorrhagia. British Journal of Obstetrics and Gynaecology, 1977, 84, 763–68.CrossRefGoogle ScholarPubMed
25.Higham, I., & Shaw, R.A comparative study of danazol, a regimen of decreasing doses of danazol and norethindrone in the treatment of objectively proven unexplained menorrhagia. American Journal of Obstetrics and Gynecology, 1993, 169, 1134–39.CrossRefGoogle ScholarPubMed
26.Ingemanson, C., Sikstrom, B., Rybo, G., & Bjorkman, R.Double-blind, placebo-controlled evaluation of diclofenac in the management of patients with IUD-related menorrhagia. Advanced Therapeutics, 1991, 8, 287–92.Google Scholar
27.Intercontinental medical statistics (IMS). UK & Ireland Ltd., 1994.Google Scholar
28.Kasonde, J., & Bonnar, J.Effect of ethamsylate and aminocaproic acid on menstrual blood loss in women using intrauterine devices. British Medical Journal, 1975, 2, 21–22.CrossRefGoogle Scholar
29.Macdonald, R.Modern treatment of menorrhagia. British Journal of Obstetrics and Gynaecology, 1990, 97, 3–7.CrossRefGoogle ScholarPubMed
30.Makarainen, L., & Ylikorkala, O.Primary and myoma-associated menorrhagia: Role of prostaglandins and effects of ibuprofen. British Journal of Obstetrics and Gynaecology, 1986, 93, 974–78.CrossRefGoogle ScholarPubMed
31.Milsom, I., Andersson, K., Andersch, B., & Rybo, G.A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia. American Journal of Obstetrics and Gynecology, 1991, 164, 879–83.CrossRefGoogle Scholar
32.Muggeridge, J., & Elder, M.Mefenamic acid in the treatment of menorrhagia. Research and Clinical Forums, 1983, 5, 83–88.Google Scholar
33.Nilsson, C.Comparative quantitation of menstrual blood loss with a d-norgestrel-releasing IUD and a Nova-T-copper device. Contraception, 1977, 15, 379–87.CrossRefGoogle Scholar
34.Nilsson, L., & Rybo, G.Treatment of menorrhagia with an antifibrinolytic agent, tranexamic acid (AMCA): A double-blind investigation. Acta Obstetricia et Gynecologica Scandinavica, 1967, 46, 572–80.CrossRefGoogle Scholar
35.Preston, J., Cameron, I., Adams, E., & Smith, S.Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. British Journal of Obstetrics and Gynaecology, 1995, 102, 401–06.CrossRefGoogle ScholarPubMed
36.Rees, M.Role of menstrual blood loss measurement in management of complaints of excessive menstrual bleeding. British Journal of Obstetrics and Gynaecology, 1991, 98, 327–28.CrossRefGoogle ScholarPubMed
37.Rees, M., Canate-Soler, R., Lopez-Bernal, A., & Turnbull, A.Effect of fenamates on prostaglandin E receptor binding. Lancet, 1988, ii, 541–42.CrossRefGoogle Scholar
38.Roy, S., & Shaw, S.Role of prostaglandins in IUD-associated uterine bleeding: Effect of a prostaglandin synthetase (ibuprofen). Obstetrics and Gynecology, 1981, 58, 101–06.Google ScholarPubMed
39.Rybo, G.Tranexamic acid therapy effective treatment in heavy menstrual bleeding: Clinical update on safety. Therapeutic Advances, 1991, 4, 1–8.Google Scholar
40.Rybo, G., Nilsson, S., Sikstrom, B., & Nygren, K.Naproxen in menorrhagia (letter). Lancet, 1981, i, 608–09.CrossRefGoogle Scholar
41.Van Eijkeren, M., Christiaens, G., Gueze, H., & Sixma, J.Effects of mefenamic acid on menstrual hemostasis in essential menorrhagia. American Journal of Obstetrics and Gynecology, 1992, 166, 1419–28.CrossRefGoogle ScholarPubMed
42.Vargyas, J., Campeau, J., & Mishell, D.Treatment of menorrhagia with meclofenamate sodium. American Journal of Obstetrics and Gynecology, 1987, 157, 944–50.CrossRefGoogle ScholarPubMed
43.Vermylen, J., Verhaegen-Declercq, M., Verstraete, M., & Fierens, F.A double-blind study of the effect of tranexamic acid in essential menorrhagia. Thrombosis et Diathesis Haemorrhagica, 1968, 20, 583–87.Google ScholarPubMed
44.Vessey, M., Villard-Mackintosh, L., McPherson, K., Coulter, A., & Yeates, D.The epidemiology of hysterectomy: Findings in a large cohort study. British Journal of Obstetrics and Gynaecology, 1992, 99, 402–07.CrossRefGoogle Scholar
45.Ylikorkala, O., & Pekonen, F.Naproxen reduced idiopathic but not fibroma-induced menorrhagia. Obstetrics and Gynecology, 1986, 68, 10–12.Google ScholarPubMed
46.Ylikorkala, O., & Viinikka, L.Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices. British Journal of Obstetrics and Gynaecology, 1983, 90, 78–83.CrossRefGoogle ScholarPubMed