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Medical Therapies for Chronic Menorrhagia

Nelson, Anita L. MD*; Teal, Stephanie B. MD, MPH†

Obstetrical & Gynecological Survey: April 2007 - Volume 62 - Issue 4 - pp 272-281
doi: 10.1097/01.ogx.0000259228.70277.6f
CME Program: CATEGORY 1 CME REVIEW ARTICLES 10, 11, AND 12: CME REVIEW ARTICLE 12

An estimated 10%–30% of menstruating women experience menorrhagia at some time during their reproductive lives. Acute menorrhagia may present as an emergency requiring prompt medical or surgical intervention. Chronic menorrhagia affects a woman’s quality of life in her work, family, and social interactions. Medical management is the first line of therapy for chronic menorrhagia. Agents that have been used to treat menorrhagia include iron, cyclooxygenase inhibitors, desmopressin, antifibrinolytics, gonadotropin-releasing hormone agonists, androgens, combined oral contraceptives, and progestins. Progestins can be administered systemically or locally and may be given cyclically or continuously. Increased use of effective medical therapies has the potential to reduce the number of surgical procedures, such as endometrial ablation and hysterectomy.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to recall the psychosocial and medical consequences of chronic menorrhagia, summarize the safety and efficacy of various treatments, and explain that effective medical treatment can reduce the number of surgical procedures.

*Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California; and †Assistant Professor, Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2007. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Dr. Nelson has disclosed that she was a recipient of Grant/Research support from Pfizer and was/is a recipient of Grant/Research support from Berlex, Barr, and Wyeth; she was a Consultant/Advisor for DWV and was/is a Consultant/Advisor for Berlex, Barr, and Wyeth; and she was/is a member of the Speakers Bureau for Barr, Berlex, TherRx, Esprit, Organon, and Merck. Dr. Teal has disclosed that she was/is a member of the Speakers Bureau for Berlex and Organon.

The authors have disclosed that nonsteroidal antiinflammatory agents, birth control pills, depot medroxyprogesterone acetate injections, levonorgestrel-releasing intrauterine system, antifibrinolytic agents, continuous medroxyprogesterone acetate and iron have not been approved by the U.S. Food and Drug Administration for use in the treatment of menorrhagia. Please consult product labeling for the approved usage of these drugs or devices.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

No reprints available.

Correspondence to: Anita L. Nelson, MD, Harbor-UCLA Medical Center, 1000 W Carson Street, Box 474, Torrance, CA 90509-2910. E-mail: anitanelsonwhc@earthlink.net.

© 2007 Lippincott Williams & Wilkins, Inc.