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BMJ. 1996 September 7; 313(7057): 579–582.
PMCID: PMC2352023

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. 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 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. MAIN OUTCOMES MEASURES: 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.

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Selected References

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  • Anderson AB, Haynes PJ, Guillebaud J, Turnbull AC. Reduction of menstrual blood-loss by prostaglandin-synthetase inhibitors. Lancet. 1976 Apr 10;1(7963):774–776. [PubMed]
  • Fraser IS, Pearse C, Shearman RP, Elliott PM, McIlveen J, Markham R. Efficacy of mefenamic acid in patients with a complaint of menorrhagia. Obstet Gynecol. 1981 Nov;58(5):543–551. [PubMed]
  • Haynes PJ, Flint AP, Hodgson H, Anderson AB, Dray F, Turnbull AC. Studies in menorrhagia: (a) mefenamic acid, (b) endometrial prostaglandin concentrations. Int J Gynaecol Obstet. 1980 May-Jun;17(6):567–572. [PubMed]
  • Larson HE, Blades R. Impairment of human polymorphonuclear leucocyte function by influenza virus. Lancet. 1976 Feb 7;1(7954):283–283. [PubMed]
  • Chamberlain G, Freeman R, Price F, Kennedy A, Green D, Eve L. A comparative study of ethamsylate and mefenamic acid in dysfunctional uterine bleeding. Br J Obstet Gynaecol. 1991 Jul;98(7):707–711. [PubMed]
  • HALLBERG L, NILSSON L. DETERMINATION OF MENSTRUAL BLOOD LOSS. Scand J Clin Lab Invest. 1964;16:244–248. [PubMed]
  • Hallberg L, Högdahl AM, Nilsson L, Rybo G. Menstrual blood loss--a population study. Variation at different ages and attempts to define normality. Acta Obstet Gynecol Scand. 1966;45(3):320–351. [PubMed]
  • Dockeray CJ, Sheppard BL, Bonnar J. Comparison between mefenamic acid and danazol in the treatment of established menorrhagia. Br J Obstet Gynaecol. 1989 Jul;96(7):840–844. [PubMed]
  • Cameron IT, Haining R, Lumsden MA, Thomas VR, Smith SK. The effects of mefenamic acid and norethisterone on measured menstrual blood loss. Obstet Gynecol. 1990 Jul;76(1):85–88. [PubMed]
  • Anderson AB, Haynes PJ, Guillebaud J, Turnbull AC. Reduction of menstrual blood-loss by prostaglandin-synthetase inhibitors. Lancet. 1976 Apr 10;1(7963):774–776. [PubMed]
  • Hall P, Maclachlan N, Thorn N, Nudd MW, Taylor CG, Garrioch DB. Control of menorrhagia by the cyclo-oxygenase inhibitors naproxen sodium and mefenamic acid. Br J Obstet Gynaecol. 1987 Jun;94(6):554–558. [PubMed]
  • Haynes PJ, Hodgson H, Anderson AB, Turnbull AC. Measurement of menstrual blood loss in patients complaining of menorrhagia. Br J Obstet Gynaecol. 1977 Oct;84(10):763–768. [PubMed]
  • Cameron IT, Leask R, Kelly RW, Baird DT. The effects of danazol, mefenamic acid, norethisterone and a progesterone-impregnated coil on endometrial prostaglandin concentrations in women with menorrhagia. Prostaglandins. 1987 Jul;34(1):99–110. [PubMed]
  • Preston JT, Cameron IT, Adams EJ, Smith SK. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. Br J Obstet Gynaecol. 1995 May;102(5):401–406. [PubMed]

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