Tranexamic acid of little help in etonogestrel-implant users with frequent, prolonged bleeding

A 5-day treatment course of tranexamic acid falls short of improving bleeding outcomes in contraceptive etonogestrel-implant users with frequent or prolonged bleeding, as reported in a study.

The study included 56 etonogestrel-implant users (mean age 24.6 years, 79 percent White, median length of implant use 574 days) with frequent (at least two independent bleeding or spotting episodes) or prolonged (≥7 consecutive days of bleeding or spotting in a 30-day interval) bleeding or spotting.

The participants were randomly assigned to receive tranexamic acid 1,300 mg (n=27) or placebo (n=29). Treatment was administered three times daily for 5 days. All participants were required to complete an e-diary daily to report bleeding patterns and study drug compliance. Bleeding was defined as needing the use of protection with a pad, tampon, or liner. Spotting, on the other hand, constituted minimal blood loss that did not require the use of any protection.

The primary outcome of the total number of days without bleeding or spotting during the 30 days following first day of treatment did not differ between the tranexamic acid and placebo groups (median, 19 vs 19 days; p=0.38).

Results for secondary outcomes were similar in the two treatment groups. Median bleeding or spotting days while on study drug was 5 days with tranexamic acid vs 5 days with placebo, and the median number of bleeding episodes was 2 in both groups.

Post-study satisfaction with the implant as contraception and acceptability of bleeding over the study period were also comparable.