Heavy Menstrual Bleeding (Menorrhagia)

Question 1

With regard to the timing of menstrual bleeding, what symptoms might indicate structural or pathological abnormality?

Answer 1

Bleeding at times other than the menses.

Question 2

What medicines can alter menstrual bleeding? (6)

Answer 2

1. Anticoagulants
2. Cimetidine
3. Monoamine oxidase inhibitors
4. Phenothiazines
5. Steroids
6. Thyroid hormones

Question 3

Endometrial and cervical carcinoma are more common in postmenopausal women. Irregular bleeding between periods, especially if associated with post coital bleeding, is extremely significant and suggests what?

Answer 3

Precancerous state or cancer of the cervix.

Question 4

What is the option for Menorrhagia POM/OTC?

Answer 4

Tranexamic acid which is an antifibrinolytic that stops the conversion of plasminogen to plasmin - an enzyme that digests fibrin and this brings about clot dissolution. Promotes clotting.

Question 5

As an OTC product, tranexamic acid is restricted to women who meet what criteria?

Answer 5

History of heavy bleeding.

Regular (21-35 day) cycles that show no more than 3 days variation in cycle duration.

Question 6

How long should the treatment of dysmenorrhoea/menorrhagia be continued before treatment is said to have failed?

Answer 6

if there are no symptom improvements within 3 menstrual cycles then use of NSAIDs and/or tranexamic acid should be stopped.

Question 7

When should tranexamic acid be taken?

Answer 7

When the bleeding starts.

Question 8

What is the dosage of tranexamic acid?

Answer 8

2 tds for max 4 days; this can be increased to 2 qds in very heavy bleeding.

Question 9

What is the maximum dosage of tranexamic acid (in g) per day?

Answer 9

eight tablets (500mg) = 4g

Question 10

What are the most common side effects of tranexamic acid?

Answer 10

Mild nausea
Vomiting
Diarrhoea

Question 11

What does NICE say about the overall rate of thrombosis in those taking tranexeaic acid?

Answer 11

No increase - however, women at high risk of thrombosis have been excluded from pharmacy supply.

Question 12

Tranexamic acid should not be taken in patients on what medications?

Answer 12

1. Anti-coagulants
2. COC
3. Unopposed oestrogen or tamoxifen.

Question 13

Is tranexamic acid safe to take in breastfeeding?

Answer 13

Unpublished study show that only small levels of tranexamic acid pass into breast milk and that waiting 3 to 4 hours before breastfeeding will minimise any risk.