Nonsurgical treatment options for heavy menstrual bleeding

Author:

Bongers M.Y.,Oderkerk T,Herman M,Geomini P.M.A.J.

Abstract

Treatment options for heavy menstrual bleeding depend on the uterine anatomy, the women’s preferences and personal ideas, her age and her future child wish. If the uterus has a normal anatomy, treatment options include hormonal or non-hormonal drugs (including levonorgestrel releasing intra-uterine systems; LNG-IUS), endometrial ablation and hysterectomy. In general, the main advantage of pharmacological treatment is the reversibility and therefore the eligibility for women, independent of age and future child-wish. This article provides a literature review on the effectiveness of medical treatment (hormonal and non-hormonal) for heavy menstrual bleeding and to discuss the dilemmas experienced by women and doctors. A literature search was performed focusing on the effectiveness of hormonal and non-hormonal medical treatment of women suffering from heavy menstrual bleeding. For nonsteroidal anti-inflammatory drugs (NSAIDs) as well as tranexamic acid, direct evidence for comparison to placebo is available, for the other agents (oral progestins (luteal phase and long term); LNG-IUS; combined hormonal contraceptives (combined oral contraceptive pills, combined vaginal ring), evidence could be extracted from a recent network meta-analysis. Evidence on treatment effects on HMB of the progesterone only pill and the etonogestrel subdermal implant is lacking. LNG-IUS appears to be the best pharmacological treatment option for HMB in terms of reducing blood loss as well as improving symptoms. Professionals should be aware that a number of women want to avoid a hormone-containing treatment, this may be due to (expected) negative side effects. In conclusion, considering pharmacological treatment of HMB without underlying pathology, LNG-IUS seems to be the best option to reduce menstrual blood loss. However, it is advised to carefully listen what women want, think and believe and to make a shared tailor-made decision. Pharmacological treatment for HMB should be initiated as a surgical intervention can be avoided. However, women who are not receptive to first-line drug treatments should be given the opportunity to improve their quality of life by getting rid of disabling symptoms of heavy menstrual bleeding, by offering treatment with endometrial ablation or hysterectomy.

Publisher

Universa BV

Subject

General Earth and Planetary Sciences,General Environmental Science

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3