PB1385 - Concurrent use of Tranexamic acid and hormonal therapy for the management of heavy menstrual bleeding in women

Background: Heavy menstrual bleeding (HMB) is the most common gynaecological symptom associated with impaired physical and social wellbeing. Both hormonal therapies and the anti-fibrinolytic Tranexamic acid (TXA) are used as a first line therapy for reducing menstrual blood loss. There are concerns that their concurrent use may increase the risk of venous thromboembolism (VTE).

Aims: The aim of this study is to review the effectiveness and safety of this combination therapy for management of HMB in women.

Methods: Retrospective data collection from electronic patient records of 175 women (100 (57%) with an inherited bleeding disorder and 75 (43%) without) with HMB who received combination therapy.

Results: The median age of the women was 20-29 years, 98 (56%) were overweight or obese. None had a personal or family history of VTE. Von Willebrand disease was the commonest bleeding disorders affecting 38 (38%) of the women. Median pictorial blood assessment chart score was 137. 28(16%) had iron deficiency anaemia and 36(20%) had uterine fibroids.

The median duration of therapy was 3 years with 88(50%) of women using the treatments for more than 4 years. Hormonal therapies used were combined oral contraceptives in 78 (44%) women, Levo-norgestrel IUS in 28 (16%), cyclical progesterone in 54(31%), Progesterone only pill (desogestrel 75mcg) in 14 (8%). 168 (96%) of women used TXA only during the period; 71(41%) of whom required TXA more than 7 days a month. 12(7%) also used TXA for other indications; bruising and epistaxis.

Median PBAC score 6 months after treatment was 71 and 150 (86%) women rated the combined therapy as effective. 18 (10%) women required an additional therapy; 6 (3%) endometrial ablation and 12 (7%) hysterectomy.

Conclusion(s): Concurrent use of TXA and hormonal therapy is safe, effective and well tolerated in women with HMB.