From the Guidelines
Treatment for menorrhagia with anemia should prioritize iron supplementation with ferrous sulphate 200 mg three times daily to correct anemia and replenish body stores, as recommended by the British Society of Gastroenterology 1. When managing menorrhagia with anemia, it is essential to address both the heavy menstrual bleeding and the resulting anemia.
- Iron supplementation is crucial to correct anemia and replenish body stores, with ferrous sulphate being the most simple and cost-effective option 1.
- The recommended dose is 200 mg three times daily, which can be adjusted based on patient response and tolerance.
- Ascorbic acid can enhance iron absorption and should be considered when response is poor 1.
- Parenteral iron should only be used when there is intolerance to at least two oral preparations or non-compliance, due to its potential for anaphylactic reactions and higher cost 1.
- In addition to iron supplementation, medical treatments for menorrhagia include hormonal options such as combined oral contraceptives or a levonorgestrel intrauterine system, as well as non-hormonal options like tranexamic acid or NSAIDs.
- Underlying causes of menorrhagia should be investigated and addressed, including fibroids, polyps, or coagulation disorders.
- Regular monitoring of hemoglobin levels is important to assess treatment effectiveness and adjust therapy as needed.
From the FDA Drug Label
1 INDICATIONS AND USAGE
Tranexamic acid tablets are indicated for the treatment of cyclic heavy menstrual bleeding 2
- Treatment for Menorrhagia with Anemia: Tranexamic acid is indicated for the treatment of cyclic heavy menstrual bleeding, which can be a cause of anemia in women.
- Key Points:
- Tranexamic acid works by diminishing the dissolution of hemostatic fibrin by plasmin, thus preserving and stabilizing fibrin's matrix structure.
- The antifibrinolytic effects of tranexamic acid can help reduce menstrual blood loss.
- Dose adjustment is needed in patients with renal impairment.
From the Research
Treatment Options for Menorrhagia with Anemia
- Medical treatment is usually considered a first-line treatment for idiopathic menorrhagia, with options including tranexamic acid, oral contraceptives, and nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5.
- Tranexamic acid has been shown to be effective in reducing menstrual blood loss by 26%-60% and is significantly more effective than placebo, NSAIDs, and oral cyclical luteal phase progestins 3, 4.
- The recommended oral dosage of tranexamic acid is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 4.
- For women with iron-deficiency anemia, iron supplementation is essential, with a recommended dose of 60-120 mg/day of elemental iron 6.
- Treatment of iron deficiency should continue for about 3 months after hemoglobin levels have returned to normal to fill iron stores 6.
Diagnosis and Assessment
- A blood count for red cells and platelets to test for anemia is recommended on a first-line basis for women consulting for abnormal uterine bleeding (AUB) whose history and/or bleeding score justify it 7.
- Pelvic ultrasound, both abdominal and transvaginal, is recommended as a first-line procedure for the etiological diagnosis of AUB 7.
- Hysteroscopy or hysterosonography can be suggested as a second-line procedure for diagnosing endometrial polyps and fibroids 5.
Management of Iron Deficiency
- Iron deficiency and iron-deficiency anemia are often associated with menometrorrhagia, and appropriate identification and treatment of iron deficiency is imperative 6.
- Iron supplementation is the most common strategy used to control iron deficiency, with oral ferrous salts being the most appropriate treatment 6.
- An extended-release formulation of ferrous sulphate with mucoproteose has been shown to be associated with a lower incidence of gastrointestinal adverse effects compared with other ferrous and ferric salts 6.