Estradiol vs Lysteda in Treatment of Heavy Menstrual Bleeding

This study is currently recruiting participants.
Verified August 2012 by Eastern Virginia Medical School
Sponsor:
Collaborator:
American College of Obstetricians and Gynecologists
Information provided by (Responsible Party):
Kay I Waud MD PhD, Eastern Virginia Medical School
ClinicalTrials.gov Identifier:
NCT01659008
First received: August 3, 2012
Last updated: August 6, 2012
Last verified: August 2012

August 3, 2012
August 6, 2012
June 2012
June 2013   (final data collection date for primary outcome measure)
menstrual blood loss [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
reduction in mean menstrual blood loss in both treatment groups
Same as current
Complete list of historical versions of study NCT01659008 on ClinicalTrials.gov Archive Site
changes in local hemostatic factors [ Time Frame: 48 hours ] [ Designated as safety issue: No ]
changes in local, endometrial hemostatic factors in both treatment groups
Same as current
Not Provided
Not Provided
 
Estradiol vs Lysteda in Treatment of Heavy Menstrual Bleeding
Estradiol Versus Tranexamic Acid on the Amount and Duration of Acute Cyclic Heavy Menstrual Bleeding

Treatment with Estradiol is non-inferior to treatment with Tranexamic acid in reducing the amount and duration of menstrual blood loss in women with cyclic heavy menstrual bleeding

BACKGROUND: The acute onset of Heavy Menstrual Bleeding (HMB) during menses results in women seeking care in the Emergency Department. The current management of HMB among our residents uses combination oral contraceptives or oral progestins. The residents in the Emergency Department often send women home without any therapeutic intervention. There is no Regulatory Agency approved therapy for acute HMB. The etiology of HMB is not well understood. Two potential causes are changes in endometrial prostaglandins and increased fibrinolytic activity in the endometrium.

Specific Aim 1 is to investigate and compare the effect of oral estradiol compared to tranexamic acid in reducing blood loss and the duration of bleeding during an acute episode HMB.

Specific Aim 2 is to evaluate the effect of estradiol and tranexamic acid on possible causes of the acute HMB by measuring prostaglandins and Plasminogen activator in menstrual effluent at the end of treatment.

METHODS: This is a randomized, double-blind, controlled, parallel-group, non-inferiority trial, with participants between the ages 18 and 45 years, with acute cyclic heavy menstrual bleeding enrolled during an emergency room visit. Participants are randomized to receive 48 hours' treatment with 1.3 mg oral tranexamic acid or 1.0 mg oral estradiol three times a day. The primary endpoint is reduction in the amount of menstrual effluent. Sample size was calculated based on detecting less than 30 ml difference between the mean menstrual blood loss of the two treatment groups. Amount of blood loss is quantified by alkaline hematin method on extraction of menstrual pads and tampons. Secondary outcome is the variation of hemostatic factors in the menstrual effluent in two treatment groups by collecting menstrual effluent and quantitating prostaglandins, Plasminogen activators, Plasminogen activator inhibitors, and vascular endothelial growth factor.

ANTICIPATED OUTCOMES: The investigators anticipate a reduction in mean menstrual blood loss in both treatment groups. Compared with participants treated with estradiol, the group treated with tranexamic acid will not have statistically significant change in reduction of menstrual effluent. We also anticipate changes in different local hemostatic factors in menstrual effluent specific to the treatment arm.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Menstrual Cycle and Uterine Bleeding Disorders
  • Drug: Estradiol
  • Drug: Lysteda
  • Experimental: estradiol
    estradiol PO 0.5mg 2 tabs three times a day for 2 days
    Intervention: Drug: Estradiol
  • Experimental: Lysteda
    Lysteda 650mg PO 2 tabs three times a day for 2 days
    Intervention: Drug: Lysteda
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
100
June 2013
June 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Age: between 18-45 years old
  • Hemoglobin concentration: less than or equal to 11.5 g/dL, greater than or equal to 8.0 g/dL
  • BMI: less than or equal to 35
  • Menstrual cycle: previous menstrual cycle interval between 26 to 34 days with less than or equal to 10 days of bleeding
  • Contraception: at least two months from implant removal, or six months from their last depo-provera or depo-Lupron injection, or recently(at least 2 months) discontinued oral, patch or intravaginal ring contraceptives
  • On cycle day 1-3 of the current menstrual bleeding episode

Exclusion Criteria:

  • NSAID, or aspirin containing medications during the 48 hours preceding the current ER visit
  • Estrogen or progestin treatment during the 30 days preceding the current ER visit
  • Using Paraguard
  • Pregnant and or lactating
  • History of endometrial ablation
  • Women with thromboembolic disease, or coagulopathy
  • Women with history of myocardial infarction, or cerebrovascular occlusion
  • Uncontrolled high blood pressure (blood pressure greater than 150/90)
  • Sensitivity to estrogen, or tranexamic acid
Female
18 Years to 45 Years
No
Contact: Kay I Waud, MD PhD 3103820090 waudk@evms.edu
Contact: David F Archer, MD 7574467444 archerdf@evms.edu
United States
 
NCT01659008
12-01-FB-0003
Yes
Kay I Waud MD PhD, Eastern Virginia Medical School
Kay I Waud MD PhD
American College of Obstetricians and Gynecologists
Principal Investigator: Kay I Waud, MD PhD Eastern Virginia Medical School department of obstetrics and gynecology
Eastern Virginia Medical School
August 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP