Use of antifibrinolytics in abnormal uterine bleeding

Pharmaceutical treatment should be considered where no structural or histological abnormality is present, or for fibroids less than 3 cm in diameter which are causing no distortion of the uterine cavity.

When compared to women with normal menstrual loss there is an increase in the levels of plasminogen activator (of the fibrinolytic system) in women with heavy menstrual bleeding. This has been used as the basis of treatment with Plasminogen activator inhibitors (antifibrinolytic agents) (1).

Tranexamic acid

• decreases blood loss by 40% - 50%
• is taken during menstruation, hence suitable for women who are trying to conceive
• is also effective in women who are using copper or an inert IUD. The effect is dose dependant o there is a 54% reduction in MBL when 3g are given daily
  • but a 71% reduction in MBL is seen when initially 6g was given for the first 5 days of bleeding, followed if necessary by 3 g
• has been shown to be superior in reducing blood loss when compared to NSAIDs, oral progestogens, and ethamsylate (1)

Antifbrinolytics do not alleviate menstrual pain (1). Side effects (mainly gastrointestinal) are reported in about one third of patients and is dose dependant

• limiting the number of days which the drug is taken will result in a reduction of adverse side effects
• although the main adverse effect of tranexamic acid is thromboembolism, longterm studies in Scandinavia have reported that the incidence of thrombosis in women receiving tranexamic acid is comparable to the spontaneous frequency of the condition in the female population (1)

Clinicians should be cautious when prescribing antifibrinolytic with the combined oral contraceptive pill (1)

Reference:

• 1. Peter Joseph O'Donovan, Charles E Miller. Modern Management of Abnormal Uterine Bleeding (2008)