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Dexamethasone...a less invasive alternative to IUS for heavy periods?



From asthma, arthritis, covid to heavy menstrual bleeding , dexamethasone appears to be one drug with many uses. Up to one third of women/people of reproductive age experience heavy menstrual bleeding (HMB). Heavy menstrual bleeding can lead to diminished quality of life and iron deficiency or anaemia which can create serious complications after surgery [1].


There are various possible interventions for HMB including surgical interventions such as hysterectomy and endometrial resection or ablation and medical interventions including oral medication or the levonorgestrel-releasing intrauterine device (LNG-IUS). Management usually depends on the individual’s subjective experience and whichever method is most acceptable to them[2]


Based on the hypothesis that endometrial glucocorticoid deficiency plays a role in the root cause of HMB, researchers have conducted a small trial using short-term treatment with Dexamethasone to reduce heavy bleeding. Findings of the DexFEM (Dexamethasone For Excessive Menstruation) study are encouraging with reduced daily menstrual loss and warrants further investigation. A daily dose of 1.8mg of dexamethasone was given for 5 days during the luteal phase of each menstrual cycle. The study included some people with fibroids.


Despite being a small trial, this study suggests that dexamethasone may be superior to IUS especially if women/people are trying to conceive or who are reluctant to have invasive surgical interventions. More larger scale studies are needed as is an assessment of the long-term adverse effects but overall this is a welcome study for a common often life disrupting condition [3].


(c) PCOS Vitality 2021

Disclaimer: Not Medical Advice.


References:


[1] D. Mansour, A. Hofmann, K. Gemzell-Danielsson, A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding, Adv. Ther. 2020 381. 38 (2020) 201–225. https://doi.org/10.1007/S12325-020-01564-Y.

[2] J. Marjoribanks, A. Lethaby, C. Farquhar, Surgery versus medical therapy for heavy menstrual bleeding, Cochrane Database Syst. Rev. 2016 (2016). https://doi.org/10.1002/14651858.CD003855.PUB3.

[3] P. Warner, L. Harriet, R. Whitaker, R.A. Parker, C.J. Weir, A. Douglas, C.H. Hansen, M. Madhra, S. Gilbert Hillier, P. Tansy, K. Saunders, J. Peter Iredale, S. Semple, D. Slayden, B.R. Walker, H. Octavia, D. Critchley, Low dose dexamethasone as treatment for women with heavy menstrual bleeding: A response-adaptive randomised placebo-controlled dose-finding parallel group trial (DexFEM)-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), (2021). https://doi.org/10.1016/j.ebiom.2021.103434.

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