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Antifibrinolytics for heavy menstrual bleeding.

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Area of Science:

  • Gynecology
  • Pharmacology
  • Evidence-based Medicine

Background:

  • Heavy menstrual bleeding (HMB) poses significant physical and social challenges for women.
  • Antifibrinolytic drugs, such as tranexamic acid (TXA), inhibit clot breakdown in the endometrium to reduce bleeding.
  • Historical concerns exist regarding a potential increased risk of venous thromboembolic disease with TXA use.

Purpose of the Study:

  • To evaluate the efficacy and safety of antifibrinolytic medications for treating heavy menstrual bleeding (HMB).
  • To compare antifibrinolytics against placebo, no treatment, and other medical interventions.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases including Cochrane, MEDLINE, Embase, and PsycINFO up to November 2017.
  • Included 13 RCTs involving 1312 participants, comparing antifibrinolytics (TXA or Kabi) with various controls.

Main Results:

  • Antifibrinolytics significantly reduced menstrual blood loss compared to placebo (moderate-quality evidence).
  • TXA showed higher improvement rates than progestogens and NSAIDs, with fewer adverse events than progestogens.
  • Evidence was insufficient for most comparisons regarding adverse events and thromboembolic events, with only one reported event overall.

Conclusions:

  • Antifibrinolytic treatment, particularly TXA, is effective for HMB compared to placebo, NSAIDs, progestogens, ethamsylate, and herbal remedies.
  • Antifibrinolytics may be less effective than the levonorgestrel-releasing intrauterine system (LIUS).
  • Limited data prevent definitive conclusions on the risk of adverse events and thromboembolism for most comparisons.