Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders

Ray, Sujoy; Ray, Amita; George, Aneesh Thomas

doi:10.1002/14651858.cd010338

Cited by 9 publications

(15 citation statements)

References 33 publications

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“… Hormonal measures High‐dose hormonal therapyHigh doses of progestogen are sufficient to control acute bleeding in most cases. If this fails, high‐dose oestrogen or gonadotropin‐releasing hormone (GnRH) agonist with simultaneous oestrogen and progesterone add‐back are alternatives 24,25 Combined oral contraceptivesCombined oral contraceptive pill (COCP) should be started once bleeding is controlled with high‐dose hormonal therapy in order to prevent recurrence.…”

Section: Treatment Of Women With Vwdmentioning

confidence: 99%

von Willebrand disease: Diagnosis and treatment, treatment of women, and genomic approach to diagnosis

2020

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von Willebrand disease (VWD) is the most common inherited bleeding disorder. VWD is caused by deficiencies in von Willebrand factor (VWF), a critical adhesive haemostatic protein. This review provides an overview of VWD diagnosis and treatment, special considerations in treating women with VWD, and current genomic approaches to VWD. For diagnosis and treatment in VWD, an accurate diagnosis is critical to providing effective treatments, determining appropriate laboratory monitoring and for counselling the patient and family. Diagnosis of VWD begins with the clinical assessment for the bleeding phenotype, which is usually characterized by mucocutaneous and provoked bleeding. The diagnosis of VWD is then made by laboratory investigation. Multiple assays are used to assess VWF levels and functions. The mainstays of VWD treatment are tailored by VWD type and symptoms, and can include antifibrinolytic treatment, desmopressin and VWF replacement treatment. Women with VWD are also at risk for excessive uterine bleeding, such as with menses and childbirth. In addition to standard VWD treatments, heavy menstrual bleeding can be treated with hormones. Interdisciplinary management of childbirth and prophylaxis in the postpartum period are needed to reduce the risk of postpartum haemorrhage. Genomic approaches to VWD can inform VWD diagnosis, treatment, test assay selection, reproductive planning and family counselling. Most VWD patients have an identifiable VWF gene DNA variant. Next‐generation sequencing is rapidly being adopted to provide more comprehensive VWF sequence information for patients with known or suspected VWD.

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Section: Treatment Of Women With Vwdmentioning

confidence: 99%

von Willebrand disease: Diagnosis and treatment, treatment of women, and genomic approach to diagnosis

2020

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“…Evidences for the use of desmopressin in AUB are scarce and still inconclusive for its recommendation. 45…”

Section: Other Therapeutic Optionsmentioning

confidence: 99%

Abnormal Uterine Bleeding

Benetti‐Pinto

Rosa‐e‐Silva

Yela

et al. 2017

Rev Bras Ginecol Obstet

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Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormal uterine bleeding, both acute and chronic. Didactically, the treatment options were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and the latter is based mainly on hormonal therapy, anti-inflammatory drugs and antifibrinolytics.

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“…Kouides et al conducted a prospective crossover study between intranasal desmopressin and oral tranexamic acid, which demonstrated that while both improved quality of life and reduced menstrual blood loss, tranexamic acid proved to be more effective [40]. A Cochrane review by Ray et al compared nonsurgical interventions for treating heavy menstrual bleeding in women with bleeding disorders [41]. There is a paucity of data showing improvement of heavy menstrual bleeding with the use of desmopressin when compared to placebo [41].…”

Section: Vasopressin Analogmentioning

confidence: 99%

“…A Cochrane review by Ray et al compared nonsurgical interventions for treating heavy menstrual bleeding in women with bleeding disorders [41]. There is a paucity of data showing improvement of heavy menstrual bleeding with the use of desmopressin when compared to placebo [41]. Additional randomized controlled trials are needed.…”

Section: Vasopressin Analogmentioning

confidence: 99%

Treatment Options for the Adolescent Patient Experiencing Abnormal Uterine Bleeding

Polis

Hertweck

2016

Curr Treat Options Peds

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Opinion statementAbnormal uterine bleeding (AUB) is one of the most common reasons adolescent patients present for gynecologic care. A new classification system has been created to provide a universally accepted system of nomenclature to describe uterine bleeding causes in reproductive-aged women. The acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and not yet classified) was introduced in 2011. This classification will help to target not only treatment but also future research into treatment options in the AUB population. In order for treatments to be effective, an accurate diagnosis is paramount. Adolescents tend to have anovulatory, infectious, or pregnancy-related causes of AUB. Traditional treatment modalities have been hormonal in nature, the most common being the use of oral contraceptive pills. The latest development has been the recognition of the effective use of the levonorgestrel intrauterine systems (LNG-IUS) in successful treatment of AUB in the adolescent population.

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Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders

Cited by 9 publications

References 33 publications

von Willebrand disease: Diagnosis and treatment, treatment of women, and genomic approach to diagnosis

von Willebrand disease: Diagnosis and treatment, treatment of women, and genomic approach to diagnosis

Abnormal Uterine Bleeding

Treatment Options for the Adolescent Patient Experiencing Abnormal Uterine Bleeding

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