From the Guidelines
Yes, Aygestin (norethindrone acetate) can be used with Lysteda (tranexamic acid) for controlling heavy uterine bleeding, as this combination approach addresses different aspects of bleeding control and is supported by recent medical guidelines. The medications work synergistically, with Aygestin helping to regulate the menstrual cycle and thin the uterine lining, and Lysteda preventing blood clot breakdown, thereby reducing bleeding 1.
Key Considerations
- Aygestin is typically taken daily, often at a dose of 5-10 mg per day, as prescribed by a healthcare provider.
- Lysteda is usually taken only during menstruation, at a dose of 1300 mg three times daily for up to 5 days.
- When using these medications together, it is crucial to follow specific dosing instructions and report any unusual side effects, such as nausea, headache, or increased blood clot risk, particularly in women with certain risk factors 1.
Monitoring and Adjustment
Regular follow-up with a healthcare provider is essential to monitor the effectiveness of the combination treatment and adjust as needed. This approach ensures that the treatment is optimized for each individual patient, minimizing potential side effects while maximizing the control of heavy uterine bleeding. The most recent guidelines support the use of tranexamic acid as a nonhormonal alternative for reducing bleeding symptoms in patients with fibroids, and the combination with a progestin like Aygestin can be an effective strategy for managing menorrhagia 1.
Treatment Goals
The primary goal of using Aygestin with Lysteda is to control heavy uterine bleeding effectively, improving the patient's quality of life. By addressing the different aspects of bleeding control, this combination can help reduce the severity and frequency of bleeding episodes, allowing patients to manage their condition more effectively. It is essential to weigh the potential benefits against the risks and consider individual patient factors, such as medical history and preferences, when deciding on a treatment plan 1.
From the FDA Drug Label
DRUG INTERACTIONS Prothrombotic Medical Products: Avoid concomitant use, can further increase the risk of thromboembolic adverse reactions associated with tranexamic acid. (5.1,7.1,8.3) The use of Aygestin (Norethindrone), a progestin, with Lysteda (Tranexamic acid) for control of heavy uterine bleeding, also known as menorrhagia, may be problematic due to the potential increased risk of thromboembolic adverse reactions.
- Key consideration: Norethindrone has prothrombotic properties.
- Clinical decision: The combination should be used with caution due to the potential increased risk of thromboembolic events 2.
From the Research
Combination Therapy for Menorrhagia
The use of Aygestin (Norethindrone) with Lysteda (Tranexamic acid) for the control of heavy uterine bleeding, also known as menorrhagia, can be considered based on the available evidence.
- A study published in 2016 3 compared the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid, and levonorgestrel-releasing intrauterine system (LNG-IUS) in treating idiopathic heavy menstrual bleeding (HMB). The results showed that NETA, tranexamic acid, and LNG-IUS reduced menstrual blood loss (MBL) by 53.1,60.8, and 85.8%, respectively, at the 6th month.
- Another study published in 2021 4 found that both oral tranexamic acid and combined oral contraceptives were equally effective in reducing the mean blood loss among patients with HMB.
- A review published in 2012 5 focused on the efficacy and safety of tranexamic acid in the treatment of idiopathic HMB, and found that tranexamic acid significantly improves the quality of life of women treated for HMB.
- A study published in 2003 6 found that tranexamic acid was more effective at reducing menstrual blood loss than mefenamic acid, flurbiprofen, etamsylate, and oral luteal phase norethisterone.
Efficacy and Safety
The efficacy and safety of combining Aygestin (Norethindrone) with Lysteda (Tranexamic acid) for the control of heavy uterine bleeding can be considered based on the available evidence.
- A review published in 2019 7 found that tranexamic acid is an effective treatment to reduce the volume of bleeding during menstruation, and has been shown to be superior to both placebo and oral progestins, and as good as combined oral contraceptives at reducing menstrual blood volume.
- The study published in 2016 3 found that satisfaction rates were comparable among the NETA (70%), tranexamic acid (63%), and LNG-IUS (77%) groups.
- The study published in 2021 4 found that both oral tranexamic acid and combined oral contraceptives were equally effective in reducing the mean blood loss among patients with HMB, and there were no severe adverse effects reported in the study.