Women who are in their reproductive selleck inhibitor years tend to choose treatment that preserves their fertility, reduces their menstrual flow, and (if possible) also acts as a form of contraception. In women over age 45, there is often still a wish to keep the uterus, even though the need to preserve fertility is reduced.1,5 Surgical treatment of HMB tends to follow failed or ineffective medical therapy. The ultimate goal of any form of treatment is to reduce menstrual flow in order to improve quality of life. The current medical and surgical treatments involved in the management of HMB, as well as their associated effects on fibroid size and fertility, are compared in Table 1. Table 1 Current Medical and Surgical Treatments Involved in the Management of Heavy Menstrual Bleeding Medical Therapies Combined Oral Contraceptive Pill Combined oral contraceptives (COCs) contain estrogen and progestogens.

They act on the hypothalamic-pituitary axis to suppress ovulation and fertility. COCs are believed to work by regulating the cycle and thinning the endometrium, which eventually leads to a lighter withdrawal bleed. The majority of COCs are monophasic; that is, they are dosed at the same strength throughout the 21-day treatment phase. COCs are generally used in 21-day treatment cycles followed by a 7-day break, during which time endometrial breakdown and loss will occur. Such withdrawal bleeding is physiologically different from the bleeding that occurs after a natural ovulatory cycle. COCs have a number of side effects, including mood changes, headaches, nausea, fluid retention, and breast tenderness.

In a recent Cochrane review assessing the effectiveness of the oral contraceptive pill in the management of menorrhagia, one randomized control trial (RCT; n = 45) focused on comparing COCs with naproxen, mefenamic acid, and danazol. This study randomly allocated 45 ovulatory women to the three treatment groups before they received mefenamic acid in two cycles and a low-dose monophasic COC or low-dose danazol for two additional cycles. The menstrual blood flow was measured in two to four control cycles and during therapy. Mefenamic acid reduced measured blood loss by 20%, 38%, and 39% in the naproxen, mefenamic acid, and danazol groups, respectively. Naproxen reduced blood loss by 12%, the oral contraceptive reduced blood loss by 43%, and danazol reduced blood loss by 49%.

6,7 Oral Progesterone Progesterone is a physiologic hormone produced during the luteal phase of the menstrual cycle. It is responsible Drug_discovery for secretory transformation of the endometrium, and bleeding occurs when endogenous levels of estrogen and progesterone fall if fertilization does not occur. Although progesterone is not available in oral formulation in the United Kingdom, a variety of oral synthetic progestogens are in clinical use. They vary in their potency and adverse effect profiles. The mechanisms by which oral progestogens reduce MBL are not fully understood.