P-45: Randomized Clinical Trial of Medroxyprogestrone Acetate and Tranexamic Acid in Women with Menorrhagia

Background: Heavy menstrual bleeding is a leading cause of poor quality of life and iron deficiency anemia in reproductive aged women. The aim of this study was to compare the efficacy and acceptability of Medroxyprogestrone acetate and Tranexamic acid in menorrhagia management. Materials and Methods: Inclusion criteria were: age 20-45 years, regular menses, not using hormonal drugs for previous 3 months, no history of systemic disease, and anemia (Hb<10.5 g/dl), no iron supplementation and finally suffering from heavy menstrual bleeding for several cycles which interfered with family and social life. Without blinding 71 eligible women were randomly allocated to tranexamic acid group (Tranexamic acid 500/Q6h on day 1-5 menstrual cycle for 3 consecutive cycles) or Medroxyprogestrone acetate (MPA 10 mg on day 5-26 menstrual cycle for 3 consecutive cycles). Changes in duration and amount of bleeding (PBLAC scores), quality of life (SF-36 and Aberdeen menorrhagia questionnaire) and also Hemoglobin and Ferritin values were checked and compared before and after treatment between two groups. Results: There were no significant differences in age, parity, education, baseline PBLAC scores and Hb and Ferritin values between two groups. MPA reduced PBLAC mean scores from 220/15 in control cycle to 108/81 in third intervention cycle (p<0.0001). While Tranexamic acid reduced mean PBLAC mean score from 242/86 in control cycle to 101/50 (p<0.0001). Both groups showed significant improvement in Hb, HCT and ferritin values but there was no statistically significant difference between two groups after treatment. More drug complication and less satisfaction were reported by MPA group (p=0.003, p= 0.002 respectively). Conclusion: Our results showed that TA is as effective as cyclic MPA in management of Idiopathic menorrhagia in terms of menstrual blood loss, homological indices and quality of life. Considering complications of MPA especially menstrual irregularity and spotting, and short course prescription of TA, makes TA preferred drug choice in menorrhagia management.