Tranexamic Acid: this medication may be another option to discuss with your doctor if you are experiencing bleeding discontentment associated with your depo injection. Though the name may sound a little scary, tranexamic acid (Lysteda) is actually a non-hormonal medication that prevents fibrinolysis (a normal body process that prevents naturally occurring blood clots; thereby preventing them from growing and/or bleeding). It is a synthetic derivative of the amino acid lysine. Typically, tranexamic acid is used during dental surgeries (like tooth extractions) for people who have hemophilia or prolonged bleeding time. It can also be used during orthopedic surgery to reduce blood loss. Lysteda is used as the first choice nonhormonal treatment for dysfunctional uterine bleeding; in fact, in November 2009, the U.S. Food and Drug Administration (FDA) approved tranexamic acid oral tablets for the treatment of heavy menstrual bleeding.
One hundred women who received a depo injection (all of whom were experiencing bleeding on depo) participated in a double-blind, randomized, placebo-controlled study to evaluate the effectiveness of using tranexamic acid to control depo bleeding. After being split into two groups: 50 who received 250 mg of tranexamic acid 4 times a day, for 5 days 49 who received placebo medication (1 woman had initially dropped out). Results indicated that at the end of the first week, the percentage of women whose depo bleeding had stopped was significantly higher in the tranexamic acid group than the placebo group (88% vs. 8.2%). Four weeks after initial treatment, a follow-up analysis was conducted. 68% of the women treated with tranexamic acid reported no bleeding for over 20 days whereas 0% of the women in the placebo group reported a similar bleeding-free interval. Finally, the groups showed significantly different results for mean number of spotting/bleeding days -- 5.7 days for the tranexamic acid group vs. 17.5 days of spotting for the placebo group.
Though it appears that tranexamic acid is an effective short-term treatment for irregular bleeding/spotting associated with receiving a depo injection, just like with estrogen supplementation, you and your doctor must weigh the therapeutic advantages against potential problems. Tranexamic acid may not be the right choice for individuals with certain health issues or allergies. If you are a teenager unhappy about your depo bleeding, tranexamic acid may not be a viable solution given that its safety and efficacy have not been established in women under the age of 18.
Additional Treatments to Stop bleeding After a Depo Injection:
There are a few more treatments that could potentially provide you some relief from your continuous Depo Provera bleeding. I will briefly explain some of these because they are not without pitfalls:
- Mefenamic acid (Ponstel): in short-term depo bleeding control, this medication has shown to be effective at a dose of 500 mg, two times a day, for 5 days. It does not seem to be an effective long-term solution. Mefenamic acid is a nonsteroidal anti-inflammatory drug, and there is a FDA mandated black box warning for this medication indicating that this medicine may increase the risk of heart attack, stroke, and high blood pressure, especially with long-term use. People with certain conditions should not use this medication. Using mefenamic acid may also increase the risk of ulcer or bleeding from the stomach or intestines. Another issue is that this medication does not mix well with several other medications, so serious drug interaction can occur. As always, you need to weigh all these pros and cons with your doctor.
- Valdecoxib (Bextra): at a does of 40 mg orally, once per day, for five days, Valdecoxib reduces the duration of depo bleeding episodes as well as increases the number of days bleeding-free intervals before another episode occurs. There has only been one study to evaluate valdecoxib and depo bleeding. Results indicate that a significant amount of women who used valdecoxib reported that their depo bleeding had stopped during the first week after their depo injection and reported more bleeding-free days at a 4 week follow-up assessment. Sounds good – right? The bad news, though valdecoxib received FDA-approval in November 2001, it was removed from the market in 2005 due to concerns about potential increased risk of heart attack and stroke. So, Valdecoxib is not available in the United States.
- Mifepristone (Mifeprex): this medication is best known for its use in medical abortion. However, it seems that low doses of mifepristone may actually help decrease the number of depo bleeding days in half for women who have just gotten their first depo injection. This does appear to be a potentially helpful approach; however, at this time, the only available mifepristone dose in the US is the 200mg amount intended for use to terminate a pregnancy. The low dose mifepristone formulation indicated for helping with depo bleeding is not available. It is also important to keep in mind that there are some serious health risks when using this medication. A FDA-mandated black box warning cautions that serious bleeding (that may require surgical intervention) may occur following use of this medicine. Also, severe infections could occur.
- Don’t Be Fooled: finally, there is the widely used practice of increasing the frequency of your Depo Provera injections (having them earlier than when the next depo injection is due). Many doctors recommend shortening the time between depo shots, claiming that this helps to stop depo bleeding. There have been no studies examining how effective this practice is, so if your doctor suggests it, you may be better off saying no and sticking to your regular scheduled appointments.
Hopefully, you now have some hope in managing your depo bleeding. Remember though, this situation (being stuck with unwanted side effects) is a perfect time to reiterate how important it is that you talk to your doctor about potential side effects BEFORE beginning any birth control option and especially before agreeing to your first depo injection. Research has shown that women who have been informed about the potential for either irregular (spotting) bleeding or prolonged, continuous bleeding before beginning to use Depo Provera are more likely to continue obtaining their scheduled depo injections. Knowing what to expect and being aware of side effects, like depo bleeding, prior to your first depo injection may help increase your success with this method. As always, knowledge is key when making informed contraceptive decisions.
Want to learn more? See UpToDate's topic, "Management of unscheduled bleeding in women using contraception," for additional in-depth medical information on ways to manage not only depo bleeding, but unscheduled spotting/bleeding while using Implanon, combination birth control pills, progestin-only pills and IUDs.
Edelman, Alison & Kaneshiro, Bliss. "Management of unscheduled bleeding in women using contraception." UpToDate. Accessed: April 2011.