From the Guidelines
Tranexamic acid (TXA) is not typically recommended for hemorrhagic ovarian cysts. The standard management for hemorrhagic ovarian cysts involves conservative approaches including pain control with NSAIDs or acetaminophen, monitoring for resolution, and possibly hormonal contraceptives to prevent future cysts. TXA works by inhibiting fibrinolysis and stabilizing blood clots, but there is insufficient evidence supporting its use specifically for ovarian cyst bleeding, as seen in studies such as 1 and 1. The bleeding from hemorrhagic ovarian cysts is usually self-limiting and contained within the cyst itself, not representing the type of active hemorrhage where TXA shows clear benefit, as noted in the context of trauma patients in 1 and 1. Additionally, there are theoretical concerns about using antifibrinolytics in this setting, as they might potentially increase the risk of thrombosis without clear benefit. Some guidelines, like those for post-partum hemorrhage 1, support the use of TXA in specific contexts of significant bleeding, but these do not directly apply to hemorrhagic ovarian cysts. If a patient with a hemorrhagic ovarian cyst shows signs of significant blood loss, hemodynamic instability, or severe pain, they should be evaluated promptly for possible surgical intervention rather than managed with TXA, following principles similar to those outlined for trauma patients in 1 and 1. Key considerations in managing hemorrhagic ovarian cysts include:
- Monitoring for resolution
- Pain control with NSAIDs or acetaminophen
- Possible use of hormonal contraceptives to prevent future cysts
- Evaluation for surgical intervention if there are signs of significant blood loss, hemodynamic instability, or severe pain.
From the Research
Use of TXA for Hemorrhagic Ovarian Cyst
- TXA can be used to reduce blood loss in patients with bleeding diatheses and is used in various gynaecologic and non-gynaecologic conditions 2.
- A case study reported that mid-cycle tranexamic acid improved symptoms in a patient with recurrent hemorrhagic cysts and type 1 von Willebrand disease 2.
- There is no direct evidence on the use of TXA specifically for hemorrhagic ovarian cysts, but its use in reducing bleeding in other gynaecologic conditions suggests potential benefits 3, 4.
- The management of ovarian cysts typically involves conservative management, and surgical intervention may be considered in certain cases 5, 6.
Clinical Indications for TXA
- TXA is commonly used to reduce bleeding in postpartum hemorrhage, menorrhagia, trauma-associated hemorrhage, and surgical bleeding 3.
- It has also been used to reduce menstrual blood loss in women with idiopathic menorrhagia and intrauterine contraceptive device-associated menorrhagia 4.
- The use of TXA in other bleeding disorders has been reported, but its effectiveness and safety in these conditions require further study 3.