Comparing Medications for Heavy Menstrual Bleeding: Progesterone vs. Tranexamic Acid

Inquire about medications for controlling menstrual blood flow?

Hello Dr.
Lin, I have uterine fibroids and adenomyosis, which cause heavy menstrual bleeding and anemia.
I am currently not considering a hysterectomy.
However, I have consulted two doctors at China Medical University and Taichung Veterans General Hospital, and they have differing opinions.
One prescribed progesterone to be taken for 7 days during ovulation to regulate menstrual flow, while the other prescribed tranexamic acid to be taken during heavy menstrual bleeding.
I have researched both medications' functions and side effects, and both have successfully controlled my menstrual flow.
I would like to ask Dr.
Lin which medication is more effective for control, or if it would be better to proceed with a hysterectomy.
Thank you for your response, Dr.
Lin.

Lai Xiaojie, 40~49 year old female. Ask Date: 2014/09/18

Dr. Lin Wenbin reply Obstetrics and Gynecology

There is no definitive answer to this question.
If medication can control menstrual bleeding but requires long-term use, one should not overlook the potential side effects, such as kidney damage.
If, after a period of treatment, menstrual bleeding remains heavy and anemia fluctuates, a hysterectomy may be the more appropriate option.
After all, long-term anemia can significantly harm the heart.

Reply Date: 2014/09/18

More Info

When it comes to managing heavy menstrual bleeding, particularly in the context of conditions like uterine fibroids and adenomyosis, both progesterone and tranexamic acid are commonly used medications, but they serve different purposes and have distinct mechanisms of action.

Progesterone is a hormone that plays a crucial role in regulating the menstrual cycle. It is often prescribed to help balance the effects of estrogen in women who have conditions like uterine fibroids or adenomyosis. By taking progesterone, particularly during the luteal phase of the menstrual cycle (the time after ovulation), it can help to regulate the menstrual flow and reduce the amount of bleeding. This is because progesterone can help stabilize the endometrial lining, making it less prone to excessive shedding. Side effects of progesterone can include mood changes, breast tenderness, and potential weight gain, among others.

On the other hand, tranexamic acid is an antifibrinolytic medication that works by preventing the breakdown of blood clots. It is particularly effective in reducing heavy menstrual bleeding by stabilizing the clotting process in the uterus. Tranexamic acid is typically taken during menstruation, and it can significantly reduce blood loss. Common side effects may include gastrointestinal disturbances, headache, and, in rare cases, an increased risk of thromboembolic events.

In your case, both medications have been effective in controlling menstrual bleeding, which is a positive outcome. The choice between progesterone and tranexamic acid often depends on individual patient factors, including the underlying cause of heavy bleeding, personal medical history, and tolerance to the medications.
Regarding the question of whether to continue with medication or consider a hysterectomy (surgical removal of the uterus), this is a significant decision that should be made in consultation with your healthcare provider. Hysterectomy is typically considered when other treatments have failed, or if there are concerns about the size of fibroids, persistent pain, or other complications. It is a more definitive solution but comes with its own risks and implications, including the loss of fertility.

In summary, both progesterone and tranexamic acid can be effective in managing heavy menstrual bleeding, and the best choice depends on your specific circumstances and preferences. It is essential to have an open discussion with your healthcare provider about the benefits and risks of each option, including the potential for surgery, to determine the most appropriate treatment plan for your situation.

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