Desmopressin for Heavy Menstrual Bleeding (Menorrhagia) in Women with Bleeding Disorders

Summary

A Cochrane review [Abstract] 1 included 3 cross-over studies with a total of 175 subjects. In two studies (n = 59) comparing desmopressin with placebo no clear difference between groups was found. The first of these reported a mean difference in menstrual blood loss in the desmopressin vs placebo group of 21.20 mL (95% confidence interval -19.00 to 61.50). In the second study there was no clear evidence of difference in pictorial bleeding assessment chart scores (PBAC). The third study comparing desmopressin with tranexamic acid (n = 116) found a decrease in PBAC after both treatments as compared to baseline. The decrease in these scores was greater for tranexamic acid than for desmopressin, with a mean difference of 41.6 mL (95% CI 19.6 to 63; P < 0.0002). In relation to adverse events, there was no clear difference when placebo was compared to desmopressin, or when desmopressin was compared to tranexamic acid.

Another Cochrane review [Abstract]3 assessed interventions for heavy menstrual bleeding. For first line treatments, meta-analysis included 26 studies with 1770 participants. LNG-IUS resulted in a large reduction of menstrual blood loss (MBL; mean rank 2.4, MD −105.71 mL/cycle, 95% CI −201.10 to −10.33) and was the best option. Antifibrinolytic agents reduced MBL (mean rank 3.7, MD −80.32 mL/cycle, 95% CI −127.67 to −32.98); long‐cycle progestogen reduced MBL (mean rank 4.1, MD −76.93 mL/cycle, 95% CI −153.82 to -0.50), and NSAIDs slightly reduced MBL (mean rank 6.4, MD −40.67 mL/cycle, −84.61 to 3.27). For second line treatments, hysterectomy was the best and endometrial ablation the second best option.