Medikamentöse Behandlung von starken Gebärmutterblutungen

 

General Guidelines

Drug therapy can be very useful for many women with menorrhagia 

 

 

The use of nonhormonal agents is an appropriate first choice when the menstrual cycle is regular. 

  • The first options are nonsteroidal anti-inflammatory drugs, with reported reductions in menstrual blood loss of 25% to 35%. 
  • Tranexamic acid is a drug that enhances blood clotting and is used more in Europe than in the US. It is proving to be very effective, and women might ask their physician if it is available.

Women should feel confident that they understand all of their options and exercise their own treatment preferences. 

A general drug treatment regimen for menorrhagia is as follows: 

NONHORMONAL AGENTS.
 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins (the substances that increase uterine contractions). 
  • They also have other properties that act against inflammatory factors that may be responsible for heavy menstrual bleeding. 
  • Studies suggest that they reduce bleeding by 30% to 50% and are the first choice for most women who experience heavy menstrual bleeding. 
  • Aspirin is the most common NSAID, but there are dozens of others available over the counter or by prescription. Among the most effective NSAIDs for menstrual disorders are ibuprofen, naproxen and mefenamic acid.
  • Mefenamic acid has been intensively studied and has been shown to reduce bleeding by 30% to 50%. 
  • For maximum benefit, they should be taken seven days before a period is expected. 
  • It should be noted, however, that long-term use of any NSAID can increase the risk for gastrointestinal bleeding and ulcers.


Tranexamic Acid.


  • Tranexamic acid is a synthetic form of the amino acid lysine and enhances blood clotting. 
  • It reduces menstrual blood flow by about half. 
  • It is more effective in reducing blood flow than oral progestins or NSAIDs, but is not as effective as the progestin-releasing IUD (LNG-IUS). 
  • Women reported a better quality of life with tranexamic acid than with oral progestins. 
  • Side effects, however, can include headache, nausea, and gastrointestinal distress. 
  • Tranexamic acid may be a good treatment choice for menorrhagia not caused by fibroids, endometriosis, or other uterine lesions and when hormonal agents are not an option. 
  • Women with any risk factors for blood clots should not use this agent.


HORMONAL AGENTS.

Hormonal agents are useful for women with heavy bleeding who also want to control the menstrual cycle. 


  • The best choice for women who also want effective birth control is either the combined oral contraceptive pill or a progestin containing intrauterine device
  • The levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena, FibroPlant) specifically is proving to be a particularly effective treatment for menorrhagia. 
  • Danazol and the gonadotropin-releasing hormone (GnRH) analogues are highly effective for more severe cases, but their side effects make them suitable only for short-term use. These agents are also useful as pretreatment before procedures used to destroy the uterine lining. Both are effective, but GnRH analogues may be slightly better.