What treatment options are available to manage heavy menstrual bleeding in women receiving full anticoagulation?¶
Answer: Evidence to guide management is very sparse, and treatment options are limited but can be effective. The principle of therapy is to avoid anticoagulant dose reduction, skipped doses, or premature discontinuation, particularly in the acute phase of treatment (first 3–6 months).
Options:
- Hormonal therapy to control heavy menstrual bleeding, including abnormal uterine bleeding (AUB) and dysfunctional uterine bleeding (DUB), is safe while the patient is on full-dose anticoagulation.
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The MEDEA randomized trial looked at three strategies in women on factor Xa inhibitors:
- switching to dabigatran;
- continuing the factor Xa inhibitor with the addition of tranexamic acid (TXA);
- continuing without any intervention.
The trial was stopped prematurely due to poor recruitment, with only 16 randomized. The main outcome was reduction in pictorial blood loss assessment chart (PBAC) score. No conclusions could be drawn; however, adding TXA seemed promising compared with the other options. 3. The T-REX HMB RCT will start recruiting patients, randomized to TXA vs no TXA. 4. Screen for and treat iron deficiency.
Source: Management of heavy menstrual bleeding on anticoagulation