Menorrhagia

Introduction

Menorrhagia is excessive (heavy) menstrual blood loss (i.e. blood loss of 60-80 ml or more period, compared with average loss of 30-40 ml), which occurs over several consecutive cycles.

NOTE: A period normally lasts 2-7 days, with the average period being 5 days long.



Medicine-Induced Menstrual Bleeding

Occasionally, medicines can change menstrual bleeding patterns.

  • Anticoagulants
  • Monoamine oxidase inhibitors
  • Phenothiazines
  • Steroids
  • Tamoxifen
  • Thyroid hormones



Management

Oral tranexamic acid reduces the volume of menstrual blood loss by about 50% through its antifibrinolytic effect, which increases blood clotting. It provides symptomatic relief but does not resolve underlying causes.

  • Dosage varies, according to the heaviness and duration of bleeding: 1 to 1.5 g 3 or 4 times daily for the first 3-5 days of each cycle.
  • Although tranexamic acid is available as an OTC medication in oversea, it is a prescription medication at Malaysia (Group B poison).
The use of NSAID (e.g. ibuprofen, mefenamic acid and naproxen) for dysmenorrhoea may also help reduce menstrual loss, but are less effective than tranexamic acid.

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