Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.
OBJECTIVE
To compare the efficacy and acceptability of ethamsylate, mefenamic acid, and tranexamic acid for treating menorrhagia.


METHODS
Randomised controlled trial.


METHODS
A university department of obstetrics and gynaecology.


METHODS
76 women with dysfunctional uterine bleeding.


METHODS
Treatment for five days from day 1 of menses during three consecutive menstrual periods. 27 patients were randomised to take ethamsylate 500 mg six hourly, 23 patients to take mefenamic acid 500 mg eight hourly, and 26 patients to take tranexamic acid 1 g six hourly.


METHODS
Menstrual loss measured by the alkaline haematin method in three control menstrual periods and three menstrual periods during treatment; duration of bleeding; patient's estimation of blood loss; sanitary towel usage; the occurrence of dysmenorrhoea; and unwanted events.


RESULTS
Ethamsylate did not reduce mean menstrual blood loss whereas mefenamic acid reduced blood loss by 20% (mean blood loss 186 ml before treatment, 148 ml during treatment) and tranexamic acid reduced blood loss by 54% (mean blood loss 164 ml before treatment, 75 ml during treatment). Sanitary towel usage was significantly reduced in patients treated with mefenamic acid and tranexamic acid.


CONCLUSIONS
Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding. Patients with dysfunctional uterine bleeding should be offered medical treatment with tranexamic acid before a decision is made about surgery.
Bonnar
J
J
Trinity College, Department of Obstetrics and Gynaecology, St. James Hospital, Dublin, Ireland.
Sheppard
B L
BL
D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004979:Ethamsylate / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008528:Mefenamic Acid / Q000627:therapeutic use*; D008595:Menorrhagia / Q000188:drug therapy*; D052576:Menstrual Hygiene Products; D008598:Menstruation; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D016861:Cyclooxygenase Inhibitors; D006490:Hemostatics; D004979:Ethamsylate; D008528:Mefenamic Acid; D014148:Tranexamic Acid