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Related Experiment Videos

Antifibrinolytics for heavy menstrual bleeding.

I Cooke1, A Lethaby, C Farquhar

  • 1The Deanery, 9 Dean St, Cork, Ireland. inez.cooke@obs-gyn.ox.ac.uk

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary

Antifibrinolytic agents significantly reduce heavy menstrual bleeding compared to placebo, with comparable safety to other treatments. However, patient-perceived improvement was not consistently demonstrated, highlighting a need for further research into subjective outcomes.

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Area of Science:

  • Gynecology and Obstetrics
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Heavy menstrual bleeding (HMB) significantly impacts women's health, with medical therapies offering an alternative to surgery.
  • Antifibrinolytic agents, such as tranexamic acid, are used for HMB due to increased plasminogen activators in affected women.
  • Concerns regarding thrombogenic side effects of tranexamic acid are mitigated by long-term studies showing comparable incidence to spontaneous thrombosis.

Purpose of the Study:

  • To evaluate the effectiveness of antifibrinolytic agents in reducing heavy menstrual bleeding (HMB).
  • To compare antifibrinolytics against placebo and other non-surgical medical treatments for HMB.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches (MEDLINE, EMBASE, Cochrane Library).

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  • Included RCTs involved women of reproductive age with regular heavy menstrual bleeding, comparing antifibrinolytics to placebo, no treatment, or other medical therapies.
  • Four eligible trials were included in the meta-analysis; three crossover trials were discussed separately due to data extraction limitations.

    • Main Results:

    • Antifibrinolytic therapy demonstrated a significant reduction in mean blood loss compared to placebo (WMD -94.0 to -110.2).
    • Compared to other medical treatments (mefenamic acid, norethisterone, ethamsylate), antifibrinolytics also significantly reduced blood loss.
    • Patient-reported improvement in menstrual blood loss was not consistently significant, and gastrointestinal side effect rates were comparable across treatments.

    Conclusions:

    • Antifibrinolytic agents are effective in objectively reducing heavy menstrual bleeding.
    • These agents show comparable safety profiles regarding gastrointestinal side effects to other medical treatments for HMB.
    • Further research is needed to address the discrepancy between objective blood loss reduction and subjective patient perception of improvement.