Role of a non-hormonal oral anti-fibrinolytic hemostatic agent (tranexamic acid) for management of patients with dysfunctional uterine bleeding.

OBJECTIVE: Perimenaposal dysfunctional bleeding is a common complaint seen in gynecology clinics. Tranexamic acid is a cheap, over the counter hemostatic agent with antifibrinolytic activity that can be used for management of excessive menstrual bleeding. However, there are few reports analyzing its effectiveness in the management of abnormal menstrual bleeding. This study aimed to evaluate the effectiveness of oral transexamic acid treatment in patients with excessive dysfunctional perimenopausal menorrhagia. METHOD: One hundred and thirty-two consecutive patients with dysfunctional perimenepausal uterine bleeding who were admitted to Cankiri Government Hospital between March 2007 and January 2008 were prospectively enrolled into this one-sided study. All the patients were asked to fill out menstrual diaries and to come to follow-up three months after the initial evaluation. All patients took 500 mg of transexamic acid (Transamine 3x2) during their menses as the primary treatment and iron preparations if Hb was < 10 g/dl. The paired sample t-test was used for statistical evaluation. RESULTS: Mean age of the patients was 42.8 (range 38-46 yrs). Median bleeding time was nine days (range 8-12 days) and median Hb was 10.6 g/dl (range 8.2-11.7) before starting the treatment. During follow-up 45 patients were unresponsive to transamine and needed further treatments (overall response rate was 65.9%). Among responsive patients, after three cycles of transamine usage median bleeding time was five days (range 3-8 days) and median Hb values were 12.1 g/dl. CONCLUSION: Oral tranexamic acid is a reasonable treatment option for patients with excessive dysfunctional perimenopousal bleeding with a 66.0% response rate.

Current management of endometrial hyperplasia and endometrial intraepithelial neoplasia (EIN).

Endometrial hyperplasia is a commonly seen disorder in daily gynecology practice. The clinical importance of this pathological entity is the underlying risk of carrying a concomittant genital cancer or risk of progression to endometrial carcinoma during the follow-up. Despite recent advances in non-invasive techniques to define underlying endometrial cancer during the initial diagnosis of endometrial hyperplasia, none of these studies are conclusive yet. Today, in spite of intense discussions and related studies which aimed to define certain prognostic factors (WHO94 vs EIN) to predict cases that would progress to cancer, we still do not have a practical and accurate system available to use during daily practice. Treatment of endometrial hyperplasias depends on the patient's age, fertility desire and the type of hyperplasia. Progestagens are still the most commonly used medical treatment modality in these patients. Response rates are higher for cases without atypia. In selected cases, hysterectomy may be performed as a definitive treatment modality. In this review article, the current management of endometrial hyperplasias is summarized in light of the associated literature. We also give a brief overview of the EIN classification and its clinical importance.

Interval debulking in epithelial ovarian carcinomas: the past, present and the future.

Primary cytoreductive surgery followed by combination chemotherapy of paclitaxel and cisplatinum is the standard treatment for advanced staged epithelial ovarian cancers. Despite the maximal efforts to increase optimal cytoreductive success rates and related ultra-radical surgeries, five-year survival rates are still poor. Primary cytoreductive surgeries and their radicalities have been criticized since the early nineties. Interval debulking surgery (IDS) and neo-adjuvant chemotherapy (NAC) are the two suggested alternatives to the primary debulking approaches. In this article, the authors summarize and discuss the IDS approach with an associated literature review.