Hormonal contraception for the adolescent

Oral Tranexamic Acid versus Combined Oral Contraceptives for Adolescent Heavy Menstrual Bleeding: A Pilot Study

STUDY OBJECTIVE

To compare the efficacy of oral tranexamic acid (TA) with combined oral contraceptives (COC) in reducing menstrual blood loss (MBL) and improving quality of life in adolescent heavy menstrual bleeding (HMB).

DESIGN, SETTING, AND PARTICIPANTS

A prospective randomized crossover trial with 17 postmenarchal girls aged 21 years and younger with HMB who were seen at our institution.

INTERVENTIONS

Patients were randomized to group A (TA arm) or group B (COC arm), each for 3 cycles, with crossover to the second arm after 1-month washout.

MAIN OUTCOME MEASURES

The primary end points were difference in improvement in MBL and QOL, from baseline to end of each therapy.

RESULTS

Seventeen patients were enrolled (mean age 14.2 years, range 11.7 to 16.8 years). Nine patients completed both arms; 8 patients withdrew from the study due to adverse events or noncompliance. Compared with baseline, significant improvement (P < .05) was demonstrated by TA and COC in MBL (mean Pictorial Blood Assessment Chart score decrease: TA, 536.4; COC, 430.6) and quality of life (mean Pediatric Quality of Life Inventory(TM) version 4.0 Generic Scales score increase: TA, 15.6; COC, 16.75), but no significant difference was noted between TA and COC (P > .05). There was statistically significant reduction in the length of menstrual cycle for COC only (mean reduction 5.3 days; P = .04) and not for TA (P = .18). Ten patients (58%) experienced adverse events that were possibly drug related (TA: n = 3, 30%; COCP: n = 7, 64%).

CONCLUSION

In this pilot study, oral TA appeared as efficacious as COC in the management of adolescent HMB by reducing MBL and improving quality of life.

Vaginal ring contraception

The contraceptive vaginal ring is a relatively new combined hormonal contraceptive method. Ethinyl estradiol and etonogestrel are rapidly absorbed through the vaginal epithelium and result in a steady serum concentration. Studies have demonstrated that the efficacy and safety of the ring are equivalent to oral contraceptives (OCs). Patients report being highly satisfied with the vaginal ring and report fewer systemic side effects than do OC users. The ring provides effective cycle control as well as symptom relief for women with menorrhagia, dysmenorrhea and polycystic ovarian syndrome. A new combined contraceptive ring containing Nestorone and ethinyl estradiol is currently being investigated in a Phase 3 trial. A progesterone-releasing vaginal ring appropriate for lactating women is available in Chile and Peru. Recent studies have demonstrated that vaginal rings can also be effective means of delivering antiretroviral drugs that provide protection from HIV.