Tranexamic Acid Edges Out MPA for Effective Treatment of Heavy Menstrual Bleeding

Both medroxyprogesterone acetate (MPA) and tranexamic acid effectively treat heavy menstrual bleeding of endometrial origin, but MPA is associated with more adverse effects and less patient satisfaction than tranexamic acid, according to the results of a new study.

A typical menstrual cycle ranges from 25 to 35 days, with an average cycle of 28 days. During a normal menses, a woman loses about 2 to 3 tablespoons of blood over 3 to 7 days. However, women with heavy menstrual bleeding, or menorrhagia, lose about 5 to 6 tablespoons of blood, sometimes more, during menses.

Researchers from 3 clinics in Tehran, Iran, compared the effectiveness of MPA and tranexamic acid (TA) for treating heavy menstrual bleeding of endometrial origin (HMB) in 90 women with the condition. Of these women, 44 were randomized to receive MPA for 21 days from day 5 of menses, and 46 women were randomized to TA for 5 days from day 1 of menses. Both treatment groups took these medications for 3 consecutive menstrual cycles.

Tranexamic acid can be administered orally in tablet form or intravenously. TA is a synthetic derivative of the amino acid lysine, and is typically used during surgery to prevent excessive blood loss. MPA, a steroidal progestin that can be administered orally or as a depot injection, generally is used for contraception, hormone replacement therapy, and endometriosis.

To measure blood loss, researchers used the pictorial blood assessment chart (PBAC). Hematological assessments were made before intervention and after treatment. Quality of life was measured as well.

In both treatment groups, significant improvements were observed for mean PBAC score, duration of bleeding, hemoglobin values, and quality of life (P < 0.05). However, there was no significant difference observed for these improvements between women who used MPA and those who used TA.

Differences were noted for adverse effects and patient satisfaction, however. More drug-related complications, particularly bleeding irregularity, and less satisfaction with treatment were reported by women in the MPA group compared with those in the TA group (P = 0.003 and P = 0.002, respectively).

Overall, long-term use of MPA is as effective as TA in treating heavy menstrual bleeding and improving quality of life. However, MPA was associated with increased rates of bleeding irregularity, an adverse effect that may limit its use.

Pertinent Points:
- Treatment with MPA or TA was associated with a significant improvement in mean PBAC score, duration of bleeding, hemoglobin values, and quality of life.
- Between treatment groups, there was no significant difference in rates of improvement.
- Compared with TA, MPA was associated with higher rates of drug-related complications and lower patient satisfaction scores.

References:

Reference

Goshtasebi A, Moukhah S, Gandevani SB. Treatment of heavy menstrual bleeding of endometrial origin: randomized controlled trial of medroxyprogesterone acetate and tranexamic acid.

Arch Gynecol Obstet.

2013;288:1055-1060.