Treating Heavy Menstrual Bleeding: What's Best?
Menometrorrhagia-excessive and prolonged uterine bleeding at irregular or frequent intervals[1]—is most often caused by uterine fibroids, and symptom severity is determined by fibroid size and location. Intramural or submucosal fibroids that distort the uterine cavity can interfere with the normal uterine blood supply and contractility, and can lead to bleeding anomalies.[2] Longstanding menometrorrhagia depletes iron stores, resulting in anemia. Anemia lowers a woman's physical endurance, significantly affecting her quality of life.
Medical treatments that suppress steroid hormone levels, such as gonadotropin-releasing hormone (GnRH) agonists, have been shown to be effective in heavy menstrual bleeding.[3] GnRH antagonists also suppress estradiol levels, but through different mechanisms. A recent study[4] compared the efficacy of an oral GnRH antagonist (relugolix) with a GnRH agonist (leuprorelin) in the clinical management of fibroids that cause heavy menstrual bleeding.
This was a double-dummy, double-blind, randomized, controlled trial. Reproductive-aged women (n = 281) with heavy menstrual bleeding (score > 120 on a pictorial blood loss assessment chart) related to fibroids were randomly assigned to receive 40-mg oral relugolix tablets daily or either 1.88 or 3.75 mg of leuprorelin (depending on weight) for 24 weeks. Baseline characteristics of the women, including fibroid and uterine volume as well as degree of heavy bleeding, were similar.
