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- Title
Medical Management of Heavy Menstrual Bleeding.
- Authors
Archer, David F.
- Abstract
Heavy menstrual bleeding (HMB) is a common symptom in women accounting for 30% of Physician office visits. HMB is associated with a wide range of medical findings from leiomyomas (uterine fibroids) to hematologic dysfunctions such as von Willebrand disease. Ongoing research suggests that HMB may be due to poor blood clot formation in the endometrial vasculature and increased fibrinolytic activity in both the endometrium and menstrual effluent. The plasminogen activator system (PAS), consisting of tissue plasminogen activator (TPA) and its specific inhibitor plasminogen activator inhibitor-1 (PAI-1) are involved in the fibrinolysis of clots and destruction of collagen ground substance. Increased endometrial cyclooxygenase synthetase-2 (COX-2) results in an increase in prostaglandin E2 (PTGE2). Menstrual effluent and endometrium in women with HMB have increased PTGE2 levels and increased prostaglandin E2 receptor-1 (PTGER1) indicating a role for prostanoids in HMB. PTGE2 stimulation of human endometrial endothelial cells from women with HMB did not increase PAI-1 (Sadek, unpublished observations). Inherited deficiency of PAI-1 results in excessive bleeding. This has resulted in the hypothesis that PAI-1 deficiency leads to increased clot dissolution and degradation of endometrial ground substances resulting in excessive menstrual bleeding. Tranexamic acid (TXA) specifically treats the increased fibrinolytic activity in the endometrium and menstrual effluent of women with HMB, but only 70% of treated women reach a normal menstrual blood loss ≤ 80 mL. These findings suggest multiple causes of HMB. This review presents the available diverse medical treatment options for HMB.
- Subjects
MENORRHAGIA; UTERINE hemorrhage; TISSUE plasminogen activator; MENSTRUATION disorders; THROMBOSIS; VON Willebrand disease; PLASMINOGEN activator inhibitors
- Publication
Magyar Nőorvosok Lapja, 2024, Vol 87, Issue 2, p59
- ISSN
0025-021X
- Publication type
Article