Treatment of Menorrhagia with Tranexamic Acid

Abstract

Objective: to evaluate the efficacy of tranexamic acid for essential menorrhagia.Subjects: women 18 to 45 years of age with a complaint of heavy menstrual bleeding.Design: two pre-treatment baseline cycles were compared to three consecutive treatment cycles of tranexamic acid (one g taken orally every six hours throughout days one to three of each menstrual period).Main outcome measurements: menstrual blood loss using the pictorial blood loss assessment chart (PBAC) and blood haemoglobin (g/L).Results: all eleven patients recruited into the study had objective evidence of menorrhagia, defined as an average PBAC score of greater than or equal to 100 over two pre-treatment cycles. The median difference between baseline and treatment PBAC scores of 96.8 was statistically significant (p = 0.003, Wilcoxon Signed Ranks Test, Range = 32.8 to 432.8). This represented a median 47.4 percent decrease in menstrual blood flow. Four patients recorded a mean PBAC score of less than 100 for the three treatment cycles, indicating a return to normal menstrual flow of less than 80 mL. Three patients were anaemic upon entry into the study as defined by WHO (haemoglobin < 120 g/L). The mean difference (post trial minus pretrial) in haemoglobin concentrations of 9.5 g/L was statistically significant (P = 0.014, paired t test; 95% Confidence Interval = 3.2 to 10.6) and represented a 7.7 percent increase. Three of the women were dissatisfied with their menstrual flow during each of the three treatment cycles. No major side effects were reported.Conclusions: Tranexamic acid is an effective, well-tolerated medication for the treatment of essential menorrhagia and may be utilitized as a first line therapy.