Menorrhagia, if repeated, causes a decrease in iron reserve and anemia and subsequently,
anemia causes psychological and cardiac complications and dysfunction in other organs.
So, paying attention to menorrhagia and its treatment can lead to lower morbidity in
reproductive aged women. It is worth noticing that most of the iron deficient anemia
morbidities are the result of more than 60 ml bleeding per cycle.
The evaluation of the actual bleeding volume is not an easy task because women's
evaluation of their own bleeding volume is not reliable. 25% of the women who consider
their bleeding level as high had menstrual bleeding less than 35 ml. The estimation of
blood loss volume was done based on the number of pads or tampons soaking per day or per
cycle. The patient's estimations of the bleeding volumes are not accurate and reliable
because they are not well aware of the normal range of bleeding and their evaluations are
inexact.
Ideally, a noninvasive investigation is preferred to an invasive one and also an
economical investigation preferred to an expensive one; this applies equally to affluent
countries and third world, that is why ultrasonography by any modality if available is
considered to be a noninvasive procedure to investigate uterine lesions rather than
hysteroscopy as a preliminary step .
Various imaging techniques are used to enable the precise localization and
characterization of uterine pathology. Currently, the main diagnostic tools for AUB
include ultrasonography and diagnostic hysteroscopy.
Menorrhagia is defined as complaint of heavy menstrual bleeding over several consecutive
cycles. The upper limit of monthly bleeding is 80 ml per cycle, which is 2 standard
deviations from the mean (mean menstrual bleeding per cycle is 36 - 52ml).
Worldwide use of hormonal therapy is based on the wrong assumption that menorrhagia
happens because of imbalance in hormones and an ovulatory cycle, but the fact is most of
the women with abnormal bleeding show no evidence of hormonal imbalance and based on some
studies 95% have regular ovulatory cycles.
Antifibrinolytic medications, such tranexamic acid, function by inhibiting the breakdown
of fibrin and are useful in the management of individuals with persistent AUB. It has
been demonstrated that they can cut bleeding in these patients by 30 to 55%. For the
treatment of acute AUB, experts advise utilizing tranexamic acid intravenously (IV) or
orally.
In another study, the treatment of menorrhagia, by both mefenamic acid and tranexamic
acid.they were beneficial in controlling menstrual blood loss with significant decrease
in dysmenorrhea Minor side effects like epigastric pain, nausea, vomiting was more
frequent in mefenamic acid group. Acceptability rate was high in both groups
