title: Anti-hemorrhagic activity of Punica granatum L. flower (Persian Golnar) against heavy menstrual bleeding of endometrial origin: a double-blind, randomized controlled trial.
abstract: BACKGROUND
  Heavy menstrual bleeding of endometrial origin (HMB) is a major healthcare problem in premenopausal women and affects several aspects of women's health and quality of life (QoL). The aim of this study was to compare the efficacy of Persian Golnar (PG) and tranexamic acid (TA) on heavy menstrual bleeding of endometrial origin (HMB) and patients' QoL.
  
  
  METHODS
  A double-blind randomized controlled trial with parallel design and block randomization technique was conducted. A total of 94 women with HMB were randomly assigned to take either PG or TA for 5 days from day 1 of menses for three consecutive menstrual cycles. Blood loss was measured by the pictorial blood loss assessment chart (PBAC). Hematological assessments were made before the intervention and after treatment. QoL as a secondary outcome was evaluated using SF-36 and the menorrhagia questionnaire (MQ). Statistical analysis was performed using t-test, paired ttest, χ2 test, Mann-Whitney test, and Wilcoxon signed-rank test.
  
  
  RESULTS
  In each group, 38 women (80.8%) completed the 3-month follow-up. Both PG and TA reduced blood loss. PBAC mean (SD) score was reduced from 304.92 (176.17) and 304.44 (192.72) to 164.60 (100.24) and 143.13 (96.07) after the third treatment cycle, respectively (p< 0.001). Furthermore, mean hemoglobin, Hb (SD) concentrations in the PG and TA groups increased significantly from 12.06 (0.86) and 11.53 (0.86)mg/dl to 13.02 (0.82) and 12.72 (0.88) mg/dl (p< 0.001). QoL was significantly improved in both groups (p< 0.001). However, there were no significant differences between the groups after the intervention.
  
  
  CONCLUSIONS
  The results of the present study demonstrate the efficacy of PG in treating HMB in terms of clinical and QoL indicators.
authors.affiliation: MD, MCH specialist, Family Health Research Group, Health metrics Research center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. agoshtasebi@ihsr.ac.ir & azita_goshtasbi@yahoo.com.
authors.forename: Azita
authors.initials: A
authors.lastname: Goshtasebi
authors.affiliation: Msc, Family Health Research Group, Health metrics Research center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. zibamazarij@yahoo.com.
authors.forename: Ziba
authors.initials: Z
authors.lastname: Mazari
authors.affiliation: PhD Candidate in Reproductive Health, Reproductive Endocrinology Research centre, Research Institute for Endocrine Science, Shaheed Beheshti University of Medical Science, Tehran, Iran. s.behboudi@hotmail.com.
authors.forename: Samira
authors.initials: S
authors.lastname: Behboudi Gandevani
authors.affiliation: MD, PhD, Shahed Traditional Iranian Medicine Research Center, Tehran, Iran. naseri@shahed.ac.ir.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naseri
keywords: Bleeding; Iran; Menstrual disturbance; Punica granatum; Tranexamic acid