Oral Tranexamic Acid Versus Diosmin for Treatment of Menorrhagia in Women using Copper IUD: Randomized controlled trial

Abstract

It was reported that IUCDs were used by over than 100 millions women in the world, and is considered the second reliable method of contraception after oral hormonal contraceptives. The efficacy of modern IUCDs in actual use is superior to that of oral contraception. The first IUCD was introduced by Richter in 1909, since then many types of IUCDs were introduced. Many studies with the CopperT380A indicated a persistent increase in menstrual blood loss of about 55%. Menorrhagia is one of the most frequent side effects of intrauterine device (IUD) use, and the most common medical reasons for premature discontinuation of the IUD . From 5% to 15% of women discontinue IUD use within one year because of bleeding. In developing countries with women who are already depleted in body iron stores may prove to be deleterious to their health. The IUCD increases menstrual bleeding by its impact on several aspects of endometrial haemostasis. Some prostaglandins may cause increase vascularity and vascular permeability and some prostaglandins inhibit platelet activity, the increased production of prostaglandins may contribute to endometrial bleeding synthesis and release could be stimulated in IUCD exposed endometrium. IUCD induced menorrhagia might be correlated with poor contractility of spiral arterioles in spongeous layer of the endometrium. Also the increased fibrinolysis with IUCD is likely to arise as a result of damage to the capillary plexus causing increase and prolonged menstrual bleeding. Menorrhagia constitutes a considerable problem for many women, causing discomfort, anxiety and disruption to women's quality of life. It is the most common cause of iron deficiency anemia in women of reproductive age. According the above mentioned derangement of the haemostatic process, suggests an approach to the treatment of IUD related menorrhagia by means of oral anti-fibrinolytic agent (tranexamic acid) and oral diosmin. Tranexamic acid is a synthetic derivative of the amino acid lysine. It's available in many trade names, the one used in this study is oral (Kapron® 500) tablets. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. It inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of clot. Antifibrinolytic agents leading to reduction of menstrual blood loss by about 50%. Side effects are uncommon. While, prolonged treatment may heighten the risk of an increased thrombotic tendency such as, deep vein thrombosis, large scale studies reveal that the incidence of thrombosis in women treated by tranexamic acid is no different from the spontaneous incidence of thrombosis in women