Medical management of menorrhagia

Menorrhagia is a common complaint and accounts for 12% of referrals to gynaecology clinics. Prevalence increases with age and peaks just prior to menopause.

It has been estimated that the treatment of menorrhagia accounts for up to 1% of all healthcare costs.

Effective medical treatments do exist, but clinicians are poor prescribers of the most effective treatments.

The main classes of drugs employed for the medical treatment of menorrhagia are non-hormonal (inhibitors of prostaglandin synthesis, antifibrinolytic agents and haemostatic agents) and hormonal therapies.

First-line management of menorrhagia consists of prostaglandin inhibitors, antifibrinolytic agents, oral contraceptive pill, high dose progestogens and progesterone intra-uterine systems, which can reduce menstrual blood loss by 25%, 50%, 50%, 85% and 90%, respectively. Second-line treatment consists of danazol and GnRH agonists which reduce menstrual loss by 50% and 100%. These treatments are second line as these use is limited by side-effects and or limited duration of use.