Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid

BMJ 1996;313:579-582 (7 September)

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Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid

John Bonnar, professor and head of department,^a Brian L Sheppard, associate professor of human reproduction ^a

^a Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St James' Hospital and the Coombe Women's Hospital, Dublin

Correspondence to: Professor John Bonnar, Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland.

Abstract

Objective: To compare the efficacy and acceptability of ethamsylate,mefenamic acid, and tranexamic acid for treating menorrhagia.
Design: Randomised controlled trial.
Setting: A university department of obstetrics and gynaecology.
Subjects: 76 women with dysfunctional uterine bleeding.
Interventions: Treatment for five days from day 1 of mensesduring three consecutive menstrual periods. 27 patients wererandomised to take ethamsylate 500 mg six hourly, 23 patientsto take mefenamic acid 500 mg eight hourly, and 26 patientsto take tranexamic acid 1 g six hourly.
Main outcome measures: Menstrual loss measured by the alkalinehaematin method in three control menstrual periods and threemenstrual periods during treatment; duration of bleeding; patient'sestimation of blood loss; sanitary towel usage; the occurrenceof dysmenorrhoea; and unwanted events.
Results: Ethamsylate did not reduce mean menstrual blood losswhereas mefenamic acid reduced blood loss by 20% (mean bloodloss 186 ml before treatment, 148 ml during treatment) and tranexamicacid reduced blood loss by 54% (mean blood loss 164 ml beforetreatment, 75 ml during treatment). Sanitary towel usage wassignificantly reduced in patients treated with mefenamic acidand tranexamic acid.
Conclusions: Tranexamic acid given during menstruation is asafe and highly effective treatment for excessive bleeding.Patients with dysfunctional uterine bleeding should be offeredmedical treatment with tranexamic acid before a decision ismade about surgery.

Key messages

In any year around 5% of women aged 30-49 years visit their general practitioners with menor- rhagia
Every year in the United Kingdom around 45 000 hysterectomies and a further 10 000 endometrial ablations are performed for menor- rhagia
The commonest drug prescribed in the British Isles for menorrhagia (norethisterone) has little or no effect in reducing menstrual bleeding
Tranexamic acid (an antifibrinolytic) 1 g six to eight hourly reduces menstrual blood loss by over half and should be offered to women with dysfunc- tional bleeding before a decision is made about surgery

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