Comparative Clinical Outcomes of Tranexamic Acid, Mefenamic Acid, and Combined Oral Contraceptive Pills in the Management of Heavy Menstrual Bleeding Among Pakistani Women A Prospective Comparative
DOI:
https://doi.org/10.62497/irjgp.241Keywords:
Heavy menstrual bleeding, Tranexamic acid, Mefenamic acid, Combined oral contraceptive pills, contraceptive pills, PBAC score, AnemiaAbstract
Background: Heavy menstrual bleeding (HMB) is a frequent gynecological condition that causes anemia, poor quality of life and substantial health resource consumption, necessitating appropriate medical management of HMB.
Objective: To compare the clinical outcomes of tranexamic acid, mefenamic acid, and combined oral contraceptive pills in the management of HMB among Pakistani women through a prospective comparative study.
Methodology: The study was conducted in the period from 1st January 2024 to 1st December 2024 at the Department of Gynecology and Obstetrics, Sherpao Hospital, Peshawar. A total of 450 women diagnosed with HMB were enrolled in the study and assigned to three treatment groups (n=150 per group) based on clinical suitability and physician decision. Participants received either tranexamic acid, mefenamic acid, or combined oral contraceptive pills according to the assigned treatment regimen. They were followed for 3 consecutive menstrual cycles. Pictorial Blood Assessment Chart (PBAC) scores, hemoglobin levels, symptom improvement, treatment response, adverse effects, and patient satisfaction were used as outcome measures. Data were analyzed statistically in SPSS, and by multivariable logistic regression to determine factors predictive of treatment success.
Results: Baseline characteristics were comparable among groups. After three treatment cycles, tranexamic acid produced the greatest reduction in menstrual blood loss, with PBAC reduction of 67.61% (212.45 ± 40.86 points), followed by combined oral contraceptive pills with 62.28% (197.32 ± 38.51 points) and mefenamic acid with 53.84% (167.65 ± 39.72 points) (P<0.001). Hemoglobin improvement was highest in the tranexamic acid group (1.54 ± 0.61 g/dL), followed by combined oral contraceptive pills (1.32 ± 0.59 g/dL) and mefenamic acid (0.91 ± 0.56 g/dL) (P<0.001). Bleeding control was achieved in 134 (89.33%) patients receiving tranexamic acid, 126 (84.00%) receiving combined oral contraceptive pills, and 111 (74.00%) receiving mefenamic acid (P<0.001). Excellent treatment response was observed in 92 (61.33%), 76 (50.67%), and 51 (34.00%) patients, respectively. Tranexamic acid independently predicted successful treatment response (adjusted OR=2.84; 95% CI: 1.72–4.69; P<0.001).
Conclusion: Tranexamic acid demonstrated superior effectiveness, safety, and patient satisfaction compared with mefenamic acid and combined oral contraceptive pills, supporting its use as an effective medical therapy for HMB.
References
Davies J, Kadir RA. Heavy menstrual bleeding: an update on management. Thrombosis research. 2017 Mar 1;151:S70-7. https://doi.org/10.1016/S0049-3848(17)30072-5
Munro MG, Mast AE, Powers JM, Kouides PA, O’Brien SH, Richards T, Lavin M, Levy BS. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. American journal of obstetrics and gynecology. 2023 Jul 1;229(1):1-9. https://doi.org/10.1016/j.ajog.2023.01.017
Munro MG. Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: Framing the issue. International Journal of Gynecology & Obstetrics. 2023 Aug;162:7-13. https://doi.org/10.1002/ijgo.14943
Sriprasert I, Pakrashi T, Kimble T, Archer DF. Heavy menstrual bleeding diagnosis and medical management. Contraception and reproductive medicine. 2017 Jul 24;2(1):20. https://doi.org/10.1186/s40834-017-0047-4
Harlow SD, Campbell OM. Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries. Reproductive health matters. 2000 Jan 1;8(15):142-7. https://doi.org/10.1016/S0968-8080(00)90016-8
Jain, V., Chodankar, R.R., Maybin, J.A. et al. Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nat Rev Endocrinol 18, 290–308 (2022). https://doi.org/10.1038/s41574-021-00629-4
Al Wattar BH, Rogozińska E, Nicholson L, Fisher DJ, Bordea E, Hutchinson-Pascal N, Moss N, Hunter RM, Khan KS, Jurkovic D, Tierney JF. Treatment options for women with heavy menstrual bleeding: a protocol for comprehensive systematic review, network meta-analyses and health economic assessment. BMJ open. 2025 Apr 1;15(4):e085292. doi: 10.1136/bmjopen-2024-085292
Matteson KA, Rahn DD, Wheeler TL, Casiano E, Siddiqui NY, Harvie HS, Mamik MM, Balk EM, Sung VW, Society of Gynecologic Surgeons Systematic Review Group. Nonsurgical management of heavy menstrual bleeding: a systematic review. Obstetrics & Gynecology. 2013 Mar 1;121(3):632-43. DOI: 10.1097/AOG.0b013e3182839e0e
Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. International journal of women's health. 2012 Aug 17:413-21. https://doi.org/10.2147/IJWH.S13840
Bofill Rodriguez M, Lethaby A, Farquhar C, Cochrane Gynaecology and Fertility Group. Non‐steroidal anti‐inflammatory drugs for heavy menstrual bleeding. Cochrane database of systematic reviews. 1996 Sep 1;2019(9). https://doi.org/10.1002/14651858.CD000400
De Leo V, Musacchio MC, Cappelli V, Piomboni P, Morgante G. Hormonal contraceptives: pharmacology tailored to women's health. Human reproduction update. 2016 Sep 1;22(5):634-46. https://doi.org/10.1093/humupd/dmw016
Sriprasert I, Pakrashi T, Kimble T, Archer DF. Heavy menstrual bleeding diagnosis and medical management. Contraception and reproductive medicine. 2017 Jul 24;2(1):20. https://doi.org/10.1186/s40834-017-0047-4
MacGregor R, Jain V, Hillman S, Lumsden MA. Investigating abnormal uterine bleeding in reproductive aged women. bmj. 2022 Sep 16;378. https://doi.org/10.1136/bmj-2022-070906
Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health. 2012;4:413-21. doi: 10.2147/IJWH.S13840.
Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M, Richter HE, Eder SE, Attia GR, Patrick DL, Rubin A. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstetrics & Gynecology. 2010 Oct 1;116(4):865-75. DOI: 10.1097/AOG.0b013e3181f20177
Gupta S, Radhakrishnan N, Pandharipande A, Srivastava A. Managing heavy menstrual bleeding in adolescents with bleeding disorders: Outcomes from a pragmatic LMIC approach. Blood Cells, Molecules, and Diseases. 2026 Mar 19:103002. https://doi.org/10.1016/j.bcmd.2026.103002
Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Feb 11;2(2):CD000154. doi: 10.1002/14651858.
Rahman S, Khan FS, Samin KA, Afridi N, Ahmed M, Khan FS. Efficacy of oral tranexamic acid versus combined oral contraceptives for heavy menstrual bleeding. Cureus. 2021 Oct 29;13(10). 10.7759/cureus.19122
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