From the Guidelines
You should seek immediate medical attention for heavy vaginal bleeding while on Eliquis (apixaban) after stopping progesterone, as this combination of symptoms requires urgent evaluation. Do not stop taking Eliquis without medical guidance, as this blood thinner prevents dangerous clots, but it also increases bleeding risk 1. When you reach medical care, inform providers about both your Eliquis use (including dose and schedule) and your recent discontinuation of progesterone, as the hormone withdrawal can trigger bleeding that may be worsened by the anticoagulant. The healthcare team will need to assess the severity of bleeding, possibly adjust your medications, and determine if you need interventions to control the bleeding.
Some key considerations for managing bleeding irregularities, as outlined in the U.S. Selected Practice Recommendations for Contraceptive Use, 2024, include exploring patient goals and providing reassurance, as well as considering treatment options such as NSAIDs for 5-7 days, hormonal treatment, or antifibrinolytic agents like tranexamic acid for 5 days 1. However, given your use of Eliquis, it's crucial to prioritize managing the bleeding while also considering the risks associated with anticoagulant therapy.
The situation is concerning because Eliquis inhibits blood clotting by blocking Factor Xa in your coagulation pathway, which can make any bleeding more difficult to stop, especially when combined with hormonal fluctuations that affect the uterine lining. It's essential to follow the guidance of healthcare professionals who can assess your specific situation, including the severity of the bleeding and the potential interactions between Eliquis and hormonal changes due to stopping progesterone 1.
Given the potential for underlying health conditions to contribute to heavy vaginal bleeding, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, a thorough evaluation by a healthcare provider is necessary to determine the best course of action 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Heavy Vaginal Bleeding After Stopping Progesterone While Taking Eliquis
- Heavy vaginal bleeding can be a concern for women, especially when stopping progesterone while taking anticoagulant medications like Eliquis (apixaban) twice daily.
- According to a study on tranexamic acid for the treatment of heavy menstrual bleeding 2, this medication has proven to be an effective treatment for heavy menstrual bleeding, reducing menstrual blood loss by 26%-60%.
- Another study on cyclical progestogens for heavy menstrual bleeding 3 found that oral progestogens were originally the most commonly prescribed agents, but their effectiveness in reducing menstrual blood loss was inferior to other medical therapies, including tranexamic acid.
Management of Heavy Vaginal Bleeding
- A case report on abnormal excessive per vagina bleeding on Esmya-selective progesterone receptor modulator (SPRM) 4 highlights the potential for abnormal uterine bleeding after starting SPRM, which can lead to urgent hysterectomy.
- A 10-year observational follow-up study on rates of medical or surgical treatment for women with heavy menstrual bleeding 5 found that medical treatments can be initiated in primary care, with low rates of surgical intervention and improvement in quality of life observed 10 years later.
- Barriers to access and myths surrounding the use of tranexamic acid for management of heavy vaginal bleeding were discussed in a study 6, emphasizing the need to address individual- and structural-level barriers to ensure effective patient care and reduce health inequities in women's health.
Considerations for Women Taking Eliquis
- Women taking Eliquis (apixaban) twice daily who experience heavy vaginal bleeding after stopping progesterone should consult their healthcare provider to discuss the best course of treatment, which may include tranexamic acid or other medical therapies.
- It is essential to weigh the benefits and risks of different treatment options, considering the potential for interactions with anticoagulant medications like Eliquis.