Heavy menstrual bleeding is associated with increased local fibrinolysis. Antifibrinolytic agents have been used in women with menorrhagia with and without bleeding disorders, and have been demonstrated to decrease menstrual blood flow approximately 50% and improve quality of life. Most studies have been done with the antifibrinolytic agent tranexamic acid, a synthetic lysine derivative. Studies have been performed comparing tranexamic acid with placebo, non-steroidal anti-inflammatory agents, and progesterone in women with menorrhagia and have predominantly demonstrated a greater reduction in menstrual blood flow with tranexamic acid. In women with menorrhagia and an underlying bleeding disorder, tranexamic acid was compared to intranasal desmopressin and also demonstrated a greater reduction in menstrual blood flow. In aggregate the studies demonstrate that antifibrinolytic agents are effective medical management for women with menorrhagia with or without bleeding disorders, reducing menstrual blood flow and improving quality of life.
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