CONSERVATIVE TREATMENT

IN DUB
PREETHI RUBINATH
4011010095

Synopsis

Conservative treatment

Supportive treatment for anaemia

Hormonal therapy in DUB

Treatment Of DUB

Treat the CAUSE

treatment for menorrhagia without any obvious

organic or general diseases should be based on:

Age of the woman

Desire to retain fertility
Previous treatment
Severity of menorrhagia

Simultaneous treatment of anaemia

Conservative treatment

Indications:

Menorrhagia is not heavy

Woman is not anaemic

Management:

Menstrual chart to be observed for few months

Spontaneous cure is possible and can be awaited

Haematinic treatment

Compatible packed cell transfusion in cases of

severe anaemia due to menorrhagia
1 pack will increase the Hb level by 1-1.5g%

NSAIDs

NSAIDs:

given during menstruation for 4-5 days control

menorrhagia by 70% in ovulatory cycles, postIUCD and post-sterilization menorrhagia.

Mefenamic acid, 500mg, tds

Side effects: nausea, vomiting, dyspepsia, gastric

ulcer, diarrhoea, headache, thrombocytopenia,
autohaemolytic anaemia.

ETHAMSYLATE

Reduces capillary fragility

500mg, QID,from 5 days prior to anticipated

period upto 10 days reduces menorrhagia upto
50%

Side effects: nausea, headache, rash

TRANEXAMIC ACID

Antifibrinolytic agent

1-2g, QID, 6-7 days during menstruation (effective

in 50%)

Ethamsylate combined with 250mg tranexemic

acid is also recommended.

HORMONAL THERAPY

This is based on two major hormones involved

in the menstrual cycle:

Oestrogen
Progesterone

1. Progestogens

Main hormones used in DUB

Mechanism of action:

Induces oestradiol 17-beta-dehydrogenase, which

converts oestradiol to weak oestrone
suppresses E2 receptors.
decreases DNA synthesis
Reduces mitotic activity in the endometrium

endometrial atrophy

Progestogens- dosage

High initial dose of 10-30 mg/ day should

arrest the bleeding in 24-48 hrs, after which
5mg daily is given for 20 days.

withdrawal bleeding occurs 2-5 days after

stopping the drug and normal blood loss is
expected.
A further course of 5 mg daily for 20days is
started on 2nd or 3rd day of period cyclically for 36months (given at night to reduce side effects).

Progestogens commonly used:

Norethisterone
DMPA (depot Medroxy progesterone acetate)
Newer progestins

Duphaston 10mg does not suppress ovulation

in women who desire pregnancy, and it does
not influence lipoproteins.
Gestrinone, a 19-nortestosterone derivative,
is effective in an oral dose of 2.5mg twice
weekly or 5mg vaginal tablet thrice weekly for
6 months.

Giving progestogen only in the luteal phase is

not effective.
Three monthly depoprovera is also now
recommended to reduce the number of
menstruation in a year.
Side effects: weight gain, depression,
headache, acne, abnormal lipid profile, breast
tumours.

2. COMBINED ORAL CONTRACEPTIVES

Oestrogen therapy alone is not
recommended because of the risk of
endometrial and breast cancer.
Oral contraceptive pills are effective in only
selected women and not safe after the age
of 35yrs in smokers and obese women.
Dosage: 20-30microg EE2 + progestogens
Side effects: nausea, headache, migraine,
thrombosis, breast tenderness,
hypertension, liver and gall bladder disease
and breast cancer

SEASONALE

Seasonale (combined oestrogen and

progesterone)

Used when oestrogen is not contraindicated and

the woman also needs contraception.

Used daily for 84 days and a gap of 6 days in a

three monthly treatment.

Menstruation occurs during tablet free period.

Advantage: infrequent periods

3. DANAZOL

Danazol has a limited role when oral

contraceptives and progestogens are not
suited to a women.
Dosage: 200mg, daily, for 3-4 cycles
Side effects: hirsuitism, acne, skin rash,
breast atrophy, fluid retention, muscle
cramps, weight gain and mood changes

4. CLOMIPHENE

An antioestrogenic drug usually used in

anovulatory cycles.
Advocated if pregnancy is desired.

5. GnRH ANALOGUES

GnRH analogues- depot injection 3.6 mg given

monthly for 4-6 months or 6.6 mg implant is
nearly 100% successful.

Longer duration of treatment causes menopausal

symptoms and osteoporosis due to its antioestrogenic action.
This is counteracted by Add-back therapy using
norethisterone or tibolone.
Not useful in acute episode of bleeding as it takes
4 weeks to act.

6. SERM

Ormeloxipone- selective oestrogen receptor

modulator(SERM).

600mg twice weekly for 12 weeks and thereafter

weekly for 12 weeks.
Its anti-oestrogenic effect does not cause breast or
uterine cancer.
Agonist to cardiovascular and bone protector.

Thank you