Göran Rybo

Menstrual Blood Loss–A Population Study: Variation at different ages and attempts to define normality

The previous literature on menstrual blood loss studies was reviewed. A new study was conducted to ascertain the variation of menstrual blood loss at various ages and to establish the upper normal limit of menstrual blood loss. The study involved 476 women of all ages in Goteborg Sweden. Amenorrheic women were excluded from the study. Measurement of hemoglobin concentration plasma iron concentration and hematocrit levels indicated wide variation among women. No statistically significant differences in menstrual blood loss were observed among age groups except that women 50 and older had the highest and women 15 and under the lowest mean loss levels. It was concluded that a loss of 60-80 ml is normal; losses above 80 ml should be considered pathological.

Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: A randomized comparative trial

A 20 micrograms/24 hours levonorgestrel-releasing intrauterine contraceptive device (LNG-IUD) has, in an open randomized multicenter study, been compared to the copper-releasing device Nova T during 5 years of use; 1821 women had the LNG-IUD and 937 women had the Nova T inserted. The 5-year cumulative gross pregnancy rate was 5.9% for Nova T and 0.5% for the LNG-IUD. The local effect of levonorgestrel in the uterine cavity causes reduction of menstrual blood loss and development of oligo-amenorrhea, and the termination rates because of heavy and/or prolonged menstrual flow were significantly (P < 0.001) lower among LNG-IUD users. However, the gross termination rate because of amenorrhea was 6.0 in this group. Hb increased during use of the LNG-IUD and decreased during Nova T use, and the difference between the devices was statistically significant. The incidence of pelvic inflammatory disease (PID) was low in LNG-IUD users regardless of age, whereas in the Nova T group, the PID rate was increased among the youngest women, which makes the difference between the devices significant (P < 0.01). The gross termination rate for reasons considered to be hormonal was 12.1 in the LNG-IUD group compared to 2.0 in the Nova T group (P < 0.001). The LNG-IUD is a long-acting reversible contraceptive method for 5 years with a pregnancy rate comparable to female sterilization. The incidence of PID is low even in young women. In addition, the positive health effects such as decreased menstrual blood loss and increased blood haemoglobin concentration make the LNG-IUD a favorable combination of hormonal and intrauterine contraception.

Levonorgestrel‐releasing intrauterine device in the treatment of menorrhagia

Summary. In 20 women with menorrhagia (>80 ml blood loss per menstrual period) a levonorgestrel‐releasing intrauterine device (Lng‐IUCD) was inserted. Menstrual blood loss (MBL) was measured in two consecutive cycles before the device was inserted and after 3, 6 and 12 months of use. MBL was significantly reduced after 3 months (86%) and after 12 months the reduction was 97%. There was a significant increase (P< 0.001) in serum ferritin during the first year of Lng‐IUCD use. The Lng‐IUCD seems to be an important alternative to oral medication and to hysterectomy in the treatment of menorrhagia.

A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia

Treatment with flurbiprofen (100 mg twice a day for 5 days), tranexamic acid (1.5 gm three times a day for 3 days and 1 gm twice a day for another 2 days), and an intrauterine contraceptive device releasing 20 micrograms levonorgestrel per day was compared in women with idiopathic menorrhagia. The menstrual blood loss during two control periods in 15 women subsequently treated with flurbiprofen and tranexamic acid was 295 +/- 52 ml and 203 +/- 25.2 ml in the 16 women later fitted with a levonorgestrel-releasing intrauterine contraceptive device. Menstrual blood loss was reduced by all three forms of treatment. The reduction in menstrual blood loss expressed as a percentage of the mean of two control cycles for each form of treatment was as follows: flurbiprofen, 20.7% +/- 9.9%; tranexamic acid, 44.4% +/- 8.3%; levonorgestrel-releasing intrauterine contraceptive device after 3 months, 81.6% +/- 4.5%; levonorgestrel-releasing intrauterine contraceptive device after 6 months, 88.0% +/- 3.1%; levonorgestrel-releasing intrauterine contraceptive device after 12 months, 95.8% +/- 1.2%. The reduction in menstrual blood loss achieved by the levonorgestrel-releasing intrauterine contraceptive device was greater than that recorded with flurbiprofen (p less than 0.001) and tranexamic acid (p less than 0.01), and was greater for tranexamic acid when compared with flurbiprofen (p less than 0.05). The levonorgestrel-releasing intrauterine contraceptive device was the only form of treatment to reduce mean menstrual blood loss below 80 ml per menstruation, the upper limit of normal menstrual blood loss.

Treatment of menorrhagia

Abstract A series of 215 menorrhagic women was treated with curettage, a uterus-contracting agent (methylergobaseinmaleate), ovulation inhibitors (combined contraceptive pills), and the antifibrinolytic agents epsilon aminocaproic acid (EACA) and tranexamic acid (AMCA). Another antifibrinolytic agent, paraaminomethyl-benzoic acid (PAMBA), was used in a small series comprised of 15 women. Curettage and methylergobaseinmaleate did not significantly reduce the menstrual blood loss. Ovulation inhibitors EACA and AMCA reduced the menstrual blood loss by about 50 per cent. PAMBA was used in too small a series for the evaluation of the optimal effect, but treatment with this drug also reduced the menstrual blood loss.

Effective contraception with the levonorgestrel-releasing intrauterine device: 12-month report of a European multicenter study

The use-effectiveness of an intrauterine contraceptive device releasing 20 mcg of levonorgestrel daily (Lng-IUD), and of a Nova T copper-releasing IUD, were studied in a randomized, comparative multicenter trial. The Lng-IUD was inserted in 1821, and the Nova T in 937 women. The 12-month net pregnancy rate with the Lng-IUD (0.1 per hundred women) was significantly lower than that with the Nova T (0.9 per hundred). Removal rates for menstrual problems and/or pain were similar for the two methods (net rates 7.5 and 8.7, respectively). The 12-month continuation rates were 82.2 for the Nova T and 79.7 for the Lng-IUD. The reduction of the bleeding led to oligomenorrhea and amenorrhea in users of the Lng-IUD; the removal rate for these reasons was 1.4. The removal rate for hormonal side effects with the Lng-IUD was 2.4. Blood hemoglobin concentrations increased among users of the Lng-IUD and decreased among users of the Nova T. The results show that the Lng-IUD was a highly effective contraceptive method which reduced menstrual bleeding. It is a promising alternative for women desiring a highly effective method for long-term use.

ABSORPTION OF SUPPLEMENTAL IRON DURING PREGNANCY‐A LONGITUDINAL STUDY WITH REPEATED BONE‐MARROW STUDIES AND ABSORPTION MEASUREMENTS

Abstract. Iron absorption, bone‐marrow smears and haematological parameters were repeatedly studied during pregnancy in 50 women. The same studies were repeated two months after delivery. The material was randomly divided into two groups. Twenty‐four women were treated with 200 mg of ferrous iron daily while 26 were given placebo. The iron absorption was measured from radioiron‐labelled test doses of 100 mg ferrous iron in a whole‐body counter with high sensitivity.

Treatment Of Menorrhagia With An Antifibrinolytic Agent, Tranexamic Acid (Amca): A Double Blind Investigation

Treatment of menorrhagia with an antifibrinolytic agent tranexamic acid (AMCA) was investigated by double-blind trial and dose-response studies. 36 women aged 15-49 years were included in the study. The decrease in blood loss during AMCA treatment was statistically significant (.05 < p < .1). No difference was seen between the women with and those without fibroids. 17 of the women reported no side effects. 2 women had side effects only with the placebo and 6 did so on both regimens. In 7 women side effects occurred only with the high dosage. The main side effects were diarrhea and abdominal pains.

The Influence of the Gyne-T 380s IUD on Menstrual Blood Loss and Iron Status

The influence of the Gyne-T 380S intrauterine contraceptive device (IUD) on menstrual blood loss (MBL) and iron status (hemoglobin, hematocrit, red cell count and indices, and serum ferritin) was evaluated. MBL was determined objectively by the alkaline hematin method in 18 women (mean age 37.1 +/- 1.6 yr, range 22-46 yr) before and 3, 6 and 12 months after insertion of a Gyne-T 380S IUD. MBL prior to IUD insertion was 59 +/- 8 ml and increased to 91 +/- 11 ml (p < 0.01) 3 months after insertion. MBL then remained largely unchanged during the remainder of the observation period (6 months, 94 +/- 12 ml; 12 months, 92 +/- 13 ml). The percentage increase in MBL at the respective measurement points ranged between 54 and 59% which is comparable with previous reports regarding the increase in MBL associated with the use of a copper IUD. There were no significant changes recorded in iron status parameters during the 12-month observation period following IUD insertion. Based on the results of the present study, women from developed countries apparently tolerate an increased MBL of approximately 55% without developing iron deficiency anemia. Iron stores were unchanged indicating an adequate adaptive increase in intestinal iron absorption.

Reduction of menstrual blood loss in women suffering from idiopathic menorrhagia with a novel antifibrinolytic drug (Kabi 2161).

Objective To compare the effect of Kabi 2161 (a prodrug of tranexamic acid) and placebo on the reduction of menstrual blood loss in women suffering from idiopathic menorrhagia and to evaluate tolerance and effectiveness in a two‐dose regimen.