Advertisement

Archives of Gynecology and Obstetrics

, Volume 288, Issue 5, pp 1055–1060 | Cite as

Treatment of heavy menstrual bleeding of endometrial origin: randomized controlled trial of medroxyprogesterone acetate and tranexamic acid

  • Azita GoshtasebiEmail author
  • Somayeh Moukhah
  • Samira Behboudi Gandevani
General Gynecology

Abstract

Purpose

This study aimed at comparing the efficacy of medroxyprogesterone acetate (MPA) and tranexamic acid (TA) for treating heavy menstrual bleeding of endometrial origin (HMB).

Methods

A randomized controlled trial was carried out in three gynecology clinics in Tehran, Iran. Ninety women with the HMB of endometrial origin were randomized into the study: 44 patients took MPA for 21 days from day 5 and 46 patients took tranexamic acid for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured using the pictorial blood loss assessment chart (PBAC); hematological assessments were made before intervention and after treatment. SF-36 and HMB Questionnaire (MQ) were given to assess quality of life. Statistical analysis was performed using t test, Paired t test, χ2, Mann–Whitney, Wilcoxon signed-rank test, and repeated measure analysis.

Results

PBLC mean score, duration of bleeding and Hb values as well as quality of life were significantly improved in both groups (P < 0.05). But there was no significant deference between groups. More drug complication and less satisfaction were reported by MPA group (P = 0.003 and P = 0.002, respectively).

Conclusions

Long-term use of MPA is as effective as Tranexamic acid in treating HMB and increasing quality of life. However, bleeding irregularity side effects of MPA might limit its use.

Keywords

Heavy menstrual bleeding of endometrial origin medroxyprogesterone acetate Randomized controlled trial Tranexamic acid 

Notes

Acknowledgments

This study was funded by Tarbiat Modares University research office as part of a Midwifery Master of Science dissertation.

Conflict of interest

The authors have no conflicts to disclose.

References

  1. 1.
    Philipp CS (2011) Antifibrinolytics in women with HMB. Thromb Res 127(Suppl 3):S113–S115PubMedCrossRefGoogle Scholar
  2. 2.
    Srinil S, Jaisamrarn U (2005) Treatment of heavy menstrual bleeding of endometrial origin with tranexamic acid. Med Assoc Thail 88:1Google Scholar
  3. 3.
    Marret H, Fauconnier A, Chabbert-Buffet N, Cravello L, Golfier F, Gondry J et al (2010) Clinical practice guidelines on HMB: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol 152(2):133–137PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman EW, Lukes A, VanDrie D, Mabey RG, Gersten J, Adomako TL (2011) A dose–response study of a novel, oral tranexamic formulation for heavy menstrual bleeding. Am J Obstet Gynecol 205(4):319 e1–319.e7CrossRefGoogle Scholar
  5. 5.
    Munro MG et al (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet 113(1):3–13CrossRefGoogle Scholar
  6. 6.
    Bushnell DM, Martin ML, Moore KA, Richter HE, Rubin A, Patrick DL (2010) HMB impact questionnaire: assessing the influence of heavy menstrual bleeding on quality of life. Curr Med Res Opin 0:2745–2755CrossRefGoogle Scholar
  7. 7.
    National Institute for Health and Clinical Excellence (2007) Heavy menstrual bleeding. National Institute for Health and Clinical Excellence (NICE). Clinical Guideline 44. LondonGoogle Scholar
  8. 8.
    Lukes AS, Freeman EW, Van Drie D, Baker J, Adomako TL (2011) Safety of tranexamic acid in women with heavy menstrual bleeding: an open-label extension study. Womens Health (Lond Engl) 7(5):591–598PubMedCrossRefGoogle Scholar
  9. 9.
    Phupong V, Sophonsritsuk A, Taneepanichskul S (2006) The effect of tranexamic acid for treatment of irregular uterine bleeding secondary to Norplant® use. Contraception 73(3):253–256PubMedCrossRefGoogle Scholar
  10. 10.
    Wellington K, Wagstaff AJ (2003) Tranexamic acid: a review of its use in the management of HMB. Drugs 63(13):1417–1433PubMedCrossRefGoogle Scholar
  11. 11.
    Lethaby A, Irvine G, Cameron I (2008) Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev 23(1):CD001016. doi: 10.1002/14651858.CD001016.pub2
  12. 12.
    Kucuk T, Ertan K (2008) Continuous oral or intramuscular medroxyprogesterone acetate versus the levonorgestrel releasing intrauterine system in the treatment of perimenopausal HMB: a randomized, prospective, controlled clinical trial in female smokers. Clin Exper Obstet Gynaecol 35(1):57–60Google Scholar
  13. 13.
    Kriplani A, Kulshrestha V, Agarwal N, Diwakar S (2006) Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate. J Obstet Gynaecol 26(7):673–678PubMedCrossRefGoogle Scholar
  14. 14.
    Keppel G Wickens TD (2007) Design and analysis, Prentice Hall, NJGoogle Scholar
  15. 15.
    Janssen CA, Scholten PC, Heintz AP (1995) A simple visual assessment technique to discriminate between HMB and normal menstrual blood loss. Obstet Gynecol 85(6):977–982PubMedCrossRefGoogle Scholar
  16. 16.
    Zakherah MS, Sayed GH, El-Nashar SA, Shaaban MM (2011) Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin. Gynecol Obstet Invest 71(4):281–284PubMedCrossRefGoogle Scholar
  17. 17.
    Mazari Z, Goshtasebi A, Moukhah S, Saki F (2011) HMB Questionnaire (MQ): translation and validation study of the Iranian version. Payesh 11:83–88Google Scholar
  18. 18.
    Ruta DA, Garratt AM, Chadha YC, Flett GM, Hall MH, Russell IT (1995) Assessment of patients with HMB: how valid is a structured clinical history as a measure of health status? Qual Life Res 4(1):33–40PubMedCrossRefGoogle Scholar
  19. 19.
    Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B (2005) The short form health survey (SF-36): translation and validation study of the Iranian version. Qual Life Res 14(3):875–882PubMedCrossRefGoogle Scholar
  20. 20.
    Bubbar VK, Kreder HJ (2006) The intention-to-treat principle: a primer for the orthopaedic surgeon. J Bone Joint Surg Am 88(9):2097–2099PubMedCrossRefGoogle Scholar
  21. 21.
    Preston JT, Cameron IT, Adams EJ, Smith SK (1995) Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory HMB. BJOG 102(5):401–406CrossRefGoogle Scholar
  22. 22.
    Naoulou B, Tsai MC (2012) Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand 91(5):529–537PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Azita Goshtasebi
    • 1
    Email author
  • Somayeh Moukhah
    • 2
  • Samira Behboudi Gandevani
    • 2
  1. 1.Department of Family Health, Mother and Child Health Research CenterIranian Institute for Health Sciences Research, ACECRTehranIran
  2. 2.Midwifery and Reproductive Health Department, Medical Sciences FacultyTarbiat Modares UniversityTehranIran

Personalised recommendations