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Randomized Controlled Trial of Tranexamic Acid’s Effect on Bleeding Length: A Study on DMPA Users with Abnormal Uterine Bleeding Who Receive Low-Dose Oral Contraceptive Pill

Diponegoro University, Indonesia

Received: 7 Jul 2019; Revised: 5 Mar 2020; Accepted: 17 Mar 2020; Available online: 30 Apr 2020; Published: 30 Apr 2020.
Open Access Copyright (c) 2020 Journal of Biomedicine and Translational Research

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Background: Contraceptive injection is the most common contraception used in Indonesia. Among the contraceptive injections, depomedroxy progesterone acetate (DMPA) is the most effective method with pregnancy rate of 0,3 pregnancy in 100 women annually. Abnormal uterine bleeding (AUB) is a common side effect occurred in DMPA users which leads to the discontinuation of contraception.

Objective: To explore the effect of tranexamic acid on bleeding length for DMPA users with AUB who receive low dose Oral Contraceptive Pills (OCP).

Methods: We performed double blind randomized control trial between  two groups to investigate the effect of tranexamic in managing AUB in DMPA users who receive low dose OCP. This study was performed in Dr. Kariadi Hospital Semarang, Indonesia. Forty-four subjects were divided into two groups, equally. Group 1 received 250 mg tranexamic acid four times a day for 5 days and OCP once a day for 28 days, while Group 2 received placebo four times a day for 5 days and OCP once a day for 28 days. Both groups were evaluated for bleeding length during treatment and were analyzed using Mann Whitney for post treatment with tranexamic acid.

Results: The mean bleeding length was 5.2±3.62 days and 9.2±6.16 days in group 1 and 2 respectively. These bleeding lengths were significantly different between both groups (p=0.018). The precentage of subjects in whom bleeding was stopped during the first week after initial treatment was significantly higher in  group  1 than group 2 (77,3 % vs 45,5 %, p<0,030).

Conclusion: Tranexamic acid significantly reduced the bleeding length in DMPA users who use OCP.

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Keywords: OCP; tranexamic acid; AUB

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  1. Kaviani M, Roozbeh N, Azima S, Amoi S. Comparing the effects of tranexamic acid and mefenamic acid in IUD-induced menorrhagia: randomized controlled trial. International Journal of Community Based Nursing and Midwifery. 2013;1(4):216-223
  2. Organization WH. From MDGs to SDGs: A new era for global public health 2016-2030. World Health Organization. 2015
  3. Novak E. Berek & Novak's gynecology: Lippincott Williams & Wilkins; 2007
  4. PILLS COC. Abnormal uterine bleeding associated with hormonal contraception. Am Fam Physician. 2002;65(10):2073-2081
  5. Baziad A, Hestiantoro A, Wiweko B, Sumapradja K. Panduan tata laksana perdarahan uterus abnormal. Himpunan Endokrinologi Reproduksi dan Fertilitas Indonesia. Aceh. 2011:3-36
  6. Hassanzadeh R, Kamalifard M, Bazargani H, Charandabi S. Comparison of Continuation Rates and Reasons of Discontinuation for Cyclofem and Depot-medroxyprogesterone acetate in Rural Areas of East Azerbaijan Province, Iran. Journal of Family and Reproductive Health. 2012;6(1):23-27
  7. Sereepapong W, Chotnopparatpattara P, Taneepanichskul S, Markham R, Russell P, Fraser IS. Endometrial progesterone and estrogen receptors and bleeding disturbances in depot medroxyprogesterone acetate users. Human Reproduction. 2004;19(3):547-552
  8. Vincent A, Salamonsen L. The role of matrix metalloproteinases and leukocytes in abnormal uterine bleeding associated with progestinonly contraceptives. Human reproduction. 2000;15(suppl_3):135-143
  9. Vincent A, Zhang J, Östör A, et al. Decreased tissue inhibitor of metalloproteinase in the endometrium of women using depot medroxyprogesterone acetate: a role for altered endometrial matrix metalloproteinase/tissue inhibitor of metalloproteinase balance in the pathogenesis of abnormal uterine bleeding? Human reproduction. 2002;17(5):1189-1198
  10. Hickey M, Fraser I. A functional model for progestogen-induced breakthrough bleeding. Human Reproduction. 2000;15(suppl_3):1-6
  11. Abdel‐Aleem H, d'Arcangues C, Vogelsong KM, Gaffield ML, Gülmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database of Systematic Reviews. 2013(10)
  12. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility: lippincott Williams & wilkins; 2011
  13. d'Arcangues C. Management of vaginal bleeding irregularities induced by progestin-only contraceptives. Human Reproduction. 2000;15(suppl_3):24-29
  14. Shabaan MM, Zakherah MS, El-Nashar SA, Sayed GH. Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial. Contraception. 2011;83(1):48-54
  15. McCormack PL. Tranexamic acid. Drugs. 2012;72(5):585-617
  16. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Paper presented at: Seminars in reproductive medicine, 2011
  17. Phupong V, Sophonsritsuk A, Taneepanichskul S. The effect of tranexamic acid for treatment of irregular uterine bleeding secondary to Norplant® use. Contraception. 2006;73(3):253-256
  18. Senthong A-j, Taneepanichskul S. The effect of tranexamic acid for treatment irregular uterine bleeding secondary to DMPA use. Medical journal of the Medical Association of Thailand. 2009;92(4):461
  19. Chaudhri R, Rizvi F, Afzal M. Body weight and bleeding pattern changes in women using DMPA-SC. J Coll Physicians Surg Pak. 2009;19(10):618-621
  20. Virga NAD. Hubungan antara berat badan berlebih dengan perdarahan uterus abnormal di poli kandungan RSUD dr. Soetomo Surabaya, Universitas Airlangga; 2017
  21. Connor PD, Tavernier LA, Thomas SM, Gates D, Lytton SM. Determining risk between Depo-Provera use and increased uterine bleeding in obese and overweight women. The Journal of the American Board of Family Practice. 2002;15(1):7-10
  22. Arab M, Nasrolahi S. Health Approach in the control of Irregular Bleeding due to Depomedroxy Progesterone Acetate. Journal of Research in Health Sciences. 2005;5(2):32-36

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