Comparison of Misoprostol and Mefenamic Acid on Reducing Menstrual Bleeding in Patients Suffering From Heavy Menstrual Bleeding

  • Tahereh Eftekhar Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Marjan Ghaemi Fetal and Neonatal Research Center, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Aref Abedi Fetal and Neonatal Research Center, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Mahboobeh Shirazi Fetal and Neonatal Research Center, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
Keywords:
Dysmenorrhea, Mefenamic Acid, Menorrhagia, Misoprostol

Abstract

Objective: Heavy menstrual bleeding is one of the most frequent complaints of women. Various therapeutic approaches have been applied to treat this condition. In this study, we compared the efficacy of mefenamic acid and misoprostol in reducing menorrhagia.Materials and methods: This is a randomized clinical trial study performed on 60 patients with menorrhagia. They were divided into two equal groups and randomly received mefenamic acid or misoprostol. Cycle duration, bleeding volume (according to the pictorial blood assessment chart), hemoglobin, hematocrit, and pad count were recorded before and after treatment. Side effects of treatment regimens were recorded.Results: Blood loss volume per menstruation day in the mefenamic acid group was 118.40 ± 36.26 ml before treatment which decreased to 48.50 ± 24.71 ml after treatment (p = 0.262). Misoprostol reduced menstrual bleeding volume from 135.37 ± 34.85 ml per day to 49.40 ± 32.161 ml (p = 0.003). Mean duration of the menstrual period in patients receiveding mefenamic acid was 9.50 ± 3.27 days which decreased to 7.73 ± 2.14 days after treatment (p = 0.001). The similar change occurred in the misoprostol group and the mean duration of the menstrual period decreased from 7.70 ± 2.10 to 6.37 ± 2.29 days (p = 0.002). The number of pads used by patients in the mefenamic acid group before treatment was 23.20 ± 12.61 which was decreased to 14.33 ± 5.86 after treatment (p = 0.001). This alteration in misoprostol group was from 20.67 ± 6.12 to 15.53 ± 6.49 (p = 0.001).Conclusion: Misoprostol can significantly reduce menstrual bleeding.

References

1. Goshtasebi A, Moukhah S, Gandevani SB. Treatment of heavy menstrual bleeding of endometrial origin: randomized controlled trial of medroxyprogesterone acetate and tranexamic acid. Arch Gynecol Obstet 2013; 288:1055-60.
2. Gretchen Lentz, Rogerio Lobo, David Gershenson, Vern Katz. Comprehensive Gynecology. 6TH ed. Mosby, 2012.
3. Geirsson RT, Eggebø T. Core outcomes for reporting women's health. Acta Obstet Gynecol Scand 2014; 93: 843–4.
4. Hallberg L, Rossander-Hultén L. Iron requirements in menstruating women. Am J Clin Nutr 1991; 54: 1047-58.
5. Goldrath MH. Hysteroscopic endometrial ablation. Obstet Gynecol Clin North Am 1995; 22: 559-72.
6. Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol 2004; 190: 1216-23.
7. Sutton C. Past, present, and future of hysterectomy. J Minim Invasive Gynecol 2010; 17: 421-35.
8. Fletcher H, Mitchell S, Frederick J, Simeon D, Brown
D. Intravaginal misoprostol versus dinoprostone as cervical ripening and labor-inducing agents. Obstet Gynecol 1994; 83: 244-7.
9. Rao S. Menorrhagia. Obstetrics, Gynaecology and Reproductive Medicine 2011; 21: 254–6.
10. Brecht T. Effects of misoprostol on human circulation. Prostaglandins 1987; 33 suppl: 51-60.
11. Natov S, Schmitt F, Ikeni A, Lacour B, Hannedouche TP. Opposite renal effects of a PGE1 analog and prostacyclin in humans. Kidney Int 1994; 45: 1457-64.
12. Yip SK, Tse AO, Haines CJ, Chung TK. Misoprostol's effect on uterine arterial blood flow and fetal heart rate in early pregnancy. Obstet Gynecol 2000; 95: 232-5.
13. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2014; (8): CD005355.
14. Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update 2015; 21: 748-61.
15. Bonnar J, Sheppard B, Dockeray CJ. The haemostatic system and dysfunctional uterine bleeding. Research and Clinical Forums 1983; 5: 27-36.
16. Anderson AB, Haynes PJ, Guillebaud J, Turnbull AC. Reduction of menstrual blood-loss by prostaglandin-synthetase inhibitors. Lancet 1976; 1: 774-6.
17. Ibrahim M. El Makhzangy, Hassan M, Fady SM. Oral versus rectal misoprostol in the treatment of menorrhagia. Middle East Fertility Society Journal 2010; 15: 163-7.
18. Fraser IS, McCarron G, Markham R, Robinson M, Smyth E. Long-term treatment of menorrhagia with mefenamic acid. Obstet Gynecol 1983; 61: 109-12.
19. Tabatabaei A. A clinical randomized single blind trial of medical therapies for menorrhagia using ibuprofen and tranexamic acid. International Journal of Fertility and Sterility 2013; 7: 120.
20. Shirazi M, Ahmadi F., Shariat M, Reihaneh P, Saedi N. Pain control of medical abortion with misoprostol in the first trimester of pregnancy. Gynecology & Obstetrics 2017; 7: 449.
21. Rahimi-Sharbaf F, Adabi K, Valadan M, Shirazi M, Nekuie S, Ghaffari P,et al. The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: A randomized clinical trial. Taiwan J Obstet Gynecol 2015 ; 54: 660-5.
Published
2019-12-08
How to Cite
1.
Eftekhar T, Ghaemi M, Abedi A, Shirazi M. Comparison of Misoprostol and Mefenamic Acid on Reducing Menstrual Bleeding in Patients Suffering From Heavy Menstrual Bleeding. J Fam Reprod Health. 13(3):141-145.
Section
Original Articles