Menorrhagia: a clinical update

Determination of progesterone in commercial formulations and in non conventional micellar systems

Progesterone was determined in commercial pharmaceutical formulations and experimental micellar systems by means of two analytical methods based on liquid chromatography and derivative spectrophotometry. The chromatographic analysis, with ultraviolet detection at 245 nm, was carried out on a C8 column using a mobile phase composed of 2-propanol and a pH 2.5, 30 mM phosphate buffer. Derivative spectrophotometry (DS) used the difference between the values of the first derivative at 227.2 and 253.6 nm. Both methods require only a simple extraction procedure of progesterone from the formulations before analysis. The high-performance liquid chromatography (HPLC) procedure allows for the quantitative determination of progesterone in all pharmaceutical formulations tested (oily and alcoholic injectable solutions, gel preparations and soft capsules) and also of the newly-developed polymeric micellar system. On the contrary, the derivative spectrophotometric method is not suitable for the pharmaceutical formulation containing estradiol and for the new micellar systems. The results obtained with the two methods are in good agreement and always satisfactory in terms of precision and accuracy.

The role of blood loss and diet in the aetiology of mild iron deficiency in premenopausal adult New Zealand women

OBJECTIVE

To investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 microg/L) in the absence of anaemia (i.e. haemoglobin > or =120 g/L).

DESIGN

Cross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.

SETTING

Dunedin, New Zealand during 1996/1997.

PARTICIPANTS

Three hundred and eighty-four women aged 18-40 years.

RESULTS

The characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin-mineral supplement use in the past year.

CONCLUSIONS

There are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.

Modern treatments of menorrhagia attributable to dysfunctional uterine bleeding

Menorrhagia (excessive uterine bleeding) affects some 20 percent of the women of reproductive age worldwide. The following review describes known and theorized etiologies of the disorder, followed by a discussion of treatment options that are currently in use as well as those on the horizon. There is much interest internationally in decreasing hysterectomy rates, particularly for those women with abnormal bleeding and anatomically normal uteri. It is these women who are the focus of this paper. Pharmacotherapy and surgery are the mainstay treatments for such patients with menorrhagia secondary to dysfunctional uterine bleeding. Most commonly, hormonal and nonhormonal medications are followed by dilatation and curettage, and ultimately, in many cases, hysterectomy. Endometrial ablation techniques have been evolving since the 1980s in response to the need for an efficacious, safer, and more cost-effective alternatives to hysterectomy. Hysteroscopic ablation achieves these goals but is difficult technically and requires significant additional training even for otherwise skilled and experienced gynecologists. The current decade has seen the development of many innovative approaches to performing endometrial ablation. These methods are intended to be much simpler to perform with less risk than electrosurgical or laser endometrial ablation. The final section of this article presents the published data to date on these new technologies, which should (in their refined state) revolutionize the treatment of menorrhagia secondary to dysfunctional uterine bleeding.