Mefenamic acid and diclofenac in the treatment of menorrhagia and dysmenorrhea in dysfunctional uterine bleeding: a randomized comparative study

Background: There is a perception that Mefenamic Acid should be the preferred NSAID for menorrhagia. However, there are insufficient evidences to prove this. Further RCTs are required to compare individual NSAIDs.Purposes of the study were to assess and compare the efficacy of mefenamic acid and diclofenac in control of menorrhagia in patients with DUB, to assess and compare their analgesic effects in dysmenorrhea associated with DUB and to study their adverse effects.Methods: Sixty-eight patients were randomized into either Mefenamic Acid (n=34) or Diclofenac (n=34) group. Efficacy variables (Pictorial Blood loss Assessment Chart quantification, Number of pads used, Number of days of menstrual bleeding, Visual Analog Scale score) and adverse effects were recorded over three menstrual cycles.Results: The median reduction of menorrhagia with Mefenamic Acid was 43.39% (Range: 2.86% to 94.4%) and for Diclofenac was 57.5% (Range: 9.9% to 93.58%). The Diclofenac group showed a statistically significant decrease in median bleeding volume, median number of pads used and median number of days of bleeding compared to the Mefenamic Acid group (p<0.05, CI = 95%) but did not show a statistically significant decrease in median VAS score compared to the Mefenamic Acid group. Adverse effects with both groups were mild.Conclusions: Mefenamic Acid and Diclofenac individually managed to significantly reduce excessive bleeding compared to baseline. Diclofenac fared better than Mefenamic Acid in terms of control of excessive menstrual bleeding. Both these agents were able to reduce the menstrual pain and on comparison, were found to be equi-efficacious.

Scrub typhus: a case report

Scrub typhus is a rare rickettsial disease which is endemic in the state of Himachal Pradesh. It is caused by bacteria called Orentia tsutsugumasi and transmitted by larvae of Trombiculid mites. Though rarely seen in the plains, it should be kept as differential for a patient presenting as fever with seizure. Eschar may or may not be seen in all cases. We report a case of scrub typhus in a patient who presented with fever and seizures but no eschar.