Tranexamic acid was as effective as norethisterone in reducing menstrual blood loss and the duration of menstrual period in women with heavy menstrual bleeding (HMB), according to a study presented at RCOG 2024.

“HMB is a frequent gynaecological disorder that severely impairs women's quality of life. HMB can be managed with a variety of pharmaceutical therapies … However, there is a need for more effective medications to treat menorrhagia. The ideal treatment should be effective regardless of the underlying cause of bleeding,” according to the researchers.

The researchers conducted a study involving 60 women (mean age 28 years) with HMB at Sheikh Zayed Hospital Rahim Yar Khan in Punjab, Pakistan. Participants were randomized to receive either tranexamic acid 3 g/day or norethisterone 20 mg/day (n=30 in each group) for 5 and 21 days, respectively. Efficacy of the treatments was evaluated by measuring menstrual blood loss through the number of pads used and duration of menstrual days. [RCOG 2024, abstract eP-019]

A higher prevalence of HMB was observed among the older cohort aged 26?35 years (73.3 percent [tranexamic acid group] and 63.3 percent [norethisterone group]) compared with the younger cohort aged 16?35 years (26.7 percent and 36.7 percent, respectively).

After treatment, the mean blood loss was reduced from 98 to 64 mL in the tranexamic acid group and from 102 to 70.7 mL in the norethisterone group.

There was also a reduction in the mean number of menstrual days following treatment with tranexamic acid (from 9.4 to 6.4 days) or norethisterone (from 9.8 to 6.9 days).

Taken together, the reductions in mean blood loss (34 vs 31.3 mL; p=0.35) and menstruating days (3 vs 2.9 days; p=0.85) did not significantly differ between the tranexamic acid and norethisterone groups.

“Overall, both drugs were observed to be effective,” the researchers concluded.

In an earlier study, women with confirmed ovulatory menorrhagia who were treated with tranexamic acid 1 g (four times daily on days 1?4) experienced a reduction in mean menstrual blood loss, whereas those who received norethisterone (5 mg twice a day on days 19 and 26) had an increase. [Br J Obstet Gynaecol 1995;102:401-406]

“Tranexamic acid is a safe and effective form of medical therapy in women with menorrhagia and is highly likely to normalize blood loss in women losing 80?200 mL prior to treatment. [However, it should be noted that] norethisterone at this dose was not an effective treatment for ovulatory menorrhagia,” according to the researchers. [Br J Obstet Gynaecol 1995;102:401-406]