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Evidence summaries

Tranexamic Acid for Treating Heavy Menstrual Bleeding (Menorrhagia) in Women with Bleeding Disorders

Tranexamic acid may be effective and may be more effective than desmopressin for heavy menstrual bleeding in women with bleeding disorders. Level of evidence: "C"

Comment: The quality of evidence is downgraded by imprecise results (few patients).

Tranexamic acid is recommended over desmopressin for the reduction of heavy menstrual bleeding in patients with bleeding disorders who do not accept or tolerate hormonal treatment.

Comment: The recommendation is strong because potential benefits of the intervention clearly exceed plausible harms.

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 review [Abstract] 2 included 7 trials on antifibrinolytic therapy (tranexamic acid) for heavy menstrual bleeding in women with no known bleeding disorder, of which 4 could be included in the meta-analysis. Antifibrinolytic therapy compared to placebo showed a significant reduction in mean blood loss (WMD -94.0 95% CI -151.4 to -36.5), and significant change in mean reduction of blood loss (WMD -110.2, 95% CI -146.5 to -73.8). Antifibrinolytic therapy compared to other medications (mefenamic acid, norethisterone, or ethamslate), showed a significant reduction in mean blood loss (WMD -73.0, 95% CI -123.4 to -22.6). There were no significant differences in the frequency of reported gastrointestinal side effects with tranexamic acid when compared with either NSAIDs, oral luteal phase progestagens, or ethamsylate. Change in the quality of life measures, flooding and leakage and sex life, were significantly improved in the tranexamic acid group when compared to the oral progestagen group in one trial.

Clinical comments

Note

Date of latest search: 8 November 2016

References

  • Ray S, Ray A. Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders. Cochrane Database Syst Rev 2016;11():CD010338. [PubMed]
  • Cooke I, Lethaby A, Farquhar C. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;(2):CD000249 [Review content assessed as up-to-date: 5 April 2004]. [PubMed]

Primary/Secondary Keywords