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Dx Irregular Menstrual Bleeding Treatment: Read more...


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Observation:
Heavy Menstrual Bleeding

The Merck Manual Home Edition states:
"During the reproductive years, vaginal bleeding may be abnormal when menstrual periods are too heavy or too light, last too long, occur too often, or are irregular. Any vaginal bleeding that occurs before puberty or after menopause is considered abnormal until proven otherwise. Most causes of abnormal vaginal bleeding are not serious. Menstrual disorders include premenstrual syndrome (PMS), menstrual cramps (dysmenorrhea), dysfunctional uterine bleeding, absence of menstrual periods (amenorrhea), and premature menopause. Some disorders that are related to the reproductive organs but not specifically to the menstrual cycle, such as pelvic congestion syndrome and polycystic ovary syndrome, cause some of the same symptoms as menstrual disorders." [Editor] There can be abnormal bleeding with pregnancy and with an ectopic (pregnancy in the tube). The key words are either "pain" and "heavy" -- seek medical attention.

Medications Used in Treatment:
1. Progestins: Provera
2. Oral Contraceptives: Lo-Estrin Fe
3. Danazol
4. Androgens: Testosterone
6. Estrogen Antagonists: Evista
7. Aromatase Inhibitors: Arimidex
8. Antifibrinolytic: Lysteda
9. Surgical Aspiration/ Dilatation and Currettage


Suggested Links:
*N.H.S. United Kingdom
*Medscape

*[Editor]   In our experience, and those of others, the use of low dose danazol controls less than emergency bleeding. As a gynecologist, an office D&C (dilatation and curettage) is performed to stop the bleeding and rule out malignancy or any persistent mass. Many women whom have had persistent uterine bleeding elect to have an "endometrial ablation" invented by my colleague, Milton Goldrath, M.D. in Detroit, Michigan in 1979. The procedure worked well for 30 years; today, the Editor follows a course of mixed androgen oral therapy. Not only is the bleeding controlled, but the hormonal replacement is beneficial for maintaining bone and muscle, mental focus, and libido.

Over the last 15 years, the post-operative use of aromatase inhibitors has gained favor. The original medication, Tamoxifen, had the troubling side-effect of thickening the uterine lining and causing more uterine bleeding so it was added to Lupron®. The second generation medication was Arimidex®/anastrozole with Alesse® was better, then letrozole can be used with northisterone. The strongest of the aromatase inhibitors is Aromasin®/exemestan. Data is limited but when it has been added to Lupron® in creates a more atropic (dry) endometrium.

*[Editor] Two of the F.D.A. approved anabolic steroids described in use above have been used in menopausal women, even with breast cancer.
1) Stanozolol
has been used in patients with advanced metastatic carcinoma with almost half having a positive response.
2) Nandrolone
has been combined with the aromatase inhibitor (tamoxifen) for prophylaxis against breasts cancer recurrences. The use of these two anabolic steroids do not raise, rather they lower estradiol levels. These anabolic steroids can improve the quality of life: the women have less symptoms of menopause: they offer treatments for the hot flushes, insomnia, osteoporosis, poor memory and loss of libido. The two anabolic steroids used together will produce usually an atrophic endometrium, just as this combination 'ablates' endometriosis. [Letter to the Editor of Contemporary OB/GYN.

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