The treatment is for DUB is divided as follows:
Medical
1) Antifibrinolytics
These are taken during menstruation only. They work via reducing the fibrinolytic activity and have been shown to reduce blood loss by about 50 percent. These are good first line treatment as they are taken only during the symptomic period and have few side effects. A commonly used drug is tranexemic acid.
2) Non Steroidal Anti Inflammatory Drug(NSAIDS)
They work by inhibiting prostaglandin synthesis and could possibly reduce blood loss by 30 percent. The advantage of this drug is the usefulness in pain relieve for dysmenorrhoea. However, Madam Jaysree might not be a suitable candidate for a NSAID as she is allergic to postan.
3) Combine oral contraceptive pills
The combine OCP often induces lighter menstruation. While it has been showed to be effective in reducing menstrual flow, it?s efficacy in comparison to other medical treatment for mennorhagia has not been well evaluated. Its advantage is concurrent contraceptive for pre menopausal women. Its role is limited by the complications it might cause to older patients.
4) Progestogens
These can be given continuously via the oral pill or as a depot (Implanon or depo-provera). While effective as a treatment, withdrawal of progestogens causes withdrawal bleeding.
5) IntraUterine System(IUS)
The progesterone intrauterine device has been showed to reduce menstrual blood flow by more than 90 percent with considerably fewer side effects than systemic progestogens. Therefore, it is a highly effective alternative to both medical and surgical treatment for the treatment of menorrhagia. It also acts as a contraceptive method and compliance is not an issue with the IUS
6) Trichloroacetic Acid (TCA) instillation
A newer conservative treatment includes instilling TCA into the uterine cavity. This destroys some of the endometrial tissues. This method has been shown to have similar efficacy to that of using a GnRH agonist and thus provides a new treatment technique of conservatively treating mennorhagia.
Surgical
1) Endometrial Ablation/ resection
There are various methods of choice for endometrial ablation using heat, electrical energy to cause the removal or destruction of the endometrium. This causes ammenorhoea or a lighter period. Endometrial ablation ends fertility. The main advantage of the procedure compared to hysteroscopy is reduced complication, reduced hospital stays and reduced cost. Studies also show a reduced urinary complaints after endometrial ablationresection compared to a hysteroscopy. Although surgical complications and hospital stays are lesser, the problem of leaving some endometrial tissues with malignant potential behind remains an issue.
2) Hysterectomy
This is usually considered as a last resort. However, it is a common procedure especially in women who have completed their family. This is the most effective treatment for mennorhagia, but it also have the highest complication rate.
The vaginal hysteroscopy is the preferred route of operation compared to the abdominal approach for removal of a normal size or slightly enlarged nucleus. The vagina approach has been showed to result in improved recovery rate for the patients.
