Treatment of ovulatory dysfunctional uterine bleeding with oral misoprostol: a comparative study

Objectives: Evaluation of the effects of oral misoprostol in the control of excessive menstrual blood loss in cases of ovulatory dysfunctional uterine bleeding in comparison to antifibrinolytic and antiprostaglandin therapy. Methods: Eighty-six patients with objective menorrhagia secondary to ovulatory dysfunctional uterine bleeding completed this prospective randomized comparative clinical trial of treatment with tranexamic acid(31 patients-group I), misoprostol(29 patients-group II), and mefenamic acid(26 patients-group III). Treatment was given during menstruation for three cycles. Treatment started on day one of menstruation for five days. Menstrual blood loss was assessed before and after treatment using subjective and objective assessment. Pulsatility index (PI) and resistance index (RI) were measured from the uterine arteries before starting treatment and during the third cycle of treatment in all patients. Results: A highly statistical significant reduction in menstrual blood loss occurred by treatment in the three groups (P=0.001). Tranexamic acid produced the highest reduction in menstrual blood loss (reduced menstrual blood loss by a mean of 125.87ml which represents a reduction of 48%). Oral misoprostol was less effective than tranexamic acid (a mean reduction of 91.58ml which represents a reduction of 35.85%)but more effective than mefenamic acid (a mean reduction of 83.66ml which represents a reduction of 30.75), however the only significant statistical difference was between tranexamic and mefenamic acid (P=0.03). Patient satisfaction as shown by the desire to continue treatment after the end of the study was high in groups I (71%) and II (62%). On the other hand, only 15 (57.7%) of patients taking mefenamic acid wished to continue the treatment. There was no significant statistical difference between the three group concerning the PI and RI before and after treatment. Conclusions: Oral misoprostol can be added to the lines of treatment of ovulatory menorrhagia.