The Experience of Treatment of Patients with Gynecological Uterine Bleeding

Introduction. Uterine bleeding in gynecological practice is a vast group of nosological forms, accompanied by increased blood loss during menstruation or acyclic metrorrhagia. Quite often, bleeding is not associated with the presence of structural-anatomical changes in the organs of the reproductive system. At the basis of the dysfunctional uterine bleeding (DUB) is the imbalance of regulatory mechanisms of the hypothalamic-pituitary-ovarian axis. Application of the empirical approach in their treatment from the standpoint of: “Endocrine disorders require hormonal therapy”, – not always, nevertheless, achieves the desired goal. Aim. To study the effectiveness of the drug Tranexam (Nizhpharm, Russia) in patients with uterine myoma and DUB. Materials and methods. We examined 138 patients of the reproductive age. The I group includes 24 practically healthy women. In the II group there were 58 patients with menstrual bleeding, 28 of them were diagnosed with DUB (IIA subgroup) and 30 had small uterine myoma (IIB subgroup). In group III, 56 subjects were monitored. In the III A subgroup there were 26 women with DUB, in IIIB – 30 patients with small fibroids. The diagnosis of menorrhagia was established on the basis of the following criteria: the use of more than 20 pads or tampons per cycle, the need to replace hygiene products during the night, the presence of clots in menstrual blood more than 1.0 cm in size, the duration of bleeding is 7 days or more. Patients of group II received oral contraceptives with 30.0 μg ethinylestradiol according to the contraceptive scheme once a day, and in the bleeding period 1 tablet twice a day. In group III, Ttanexam (in tablets of 250.0 mg) was administered 1.0 g four times a day to patients with menorrhagia. Patient monitoring was performed over three menstrual cycles. In addition to general clinical examination, all 138 patients underwent ultrasound examination of pelvic organs and mammary glands, colposcopy, oncocytology. Patients were consulted by a therapist, an endocrinologist and, if necessary, a hematologist. The effectiveness of the treatment was determined based on the number of hygiene products used, the duration of menstrual bleeding, and the hemoglobin (Hb) level in the blood. The level of adverse reactions under the influence of the treatment with oral contraceptives and tranexamic acid was recorded. Results. No pronounced deviations of endocrinological status have been detected in these patients. It was found out that in women with uterine bleeding the application of the combined oral contraceptives was accompanied by higher rates of side effects such as headache, breast tenderness, nausea and vomiting compared with the application of tranexamic acid. The prescription of tranexamic acid («Tranexam») in pills in patients with menorragia had higher effectiveness than the combined oral contraceptives that was reflected in a significant decrease in a number of required sanitary facilities, duration of menstrual bleeding and a higher level of hemoglobin. The application of tranexamic acid in pills provides the confidentiality of use that increases compliance of therapy and patients' adherence to treatment. Conclusions. The administration of tranexamic acid (Tranexam) in tablets for the patients with menorrhagia surpassed the effectiveness of combined oral contraceptives, and therefore is recommended for use in such patients in routine practice.