Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with woman’s quality of life. Due to excessive blood loss, HMB can promote iron deficiency and iron deficiency anaemia, which is associated with increased risk to mother and baby in future pregnancy. Almost half of Bangladeshi adolescents are anaemic. Given that adolescent pregnancy remains common in Bangladesh, preventing iron deficiency is crucial for optimizing the health of young mothers and their children.
Several small, short-term randomized controlled trials (RCTs) in high-income countries have demonstrated the efficacy of tranexamic acid (TXA) in reducing menstrual blood loss. Oral TXA could be a cost-effective solution for adolescents in low- and middle-income countries (LMICs), including Bangladesh. Unfortunately, there are significant gaps in evidence for TXA for HMB. For example, they measured blood loss rather than clinically relevant self-reported HMB for inclusion, excluded adolescents, and did not focus on LMICs. Crucially, trials were brief (3 cycles), required invasive screening, and rarely assessed anaemia/iron status or quality of life. This evidence lacks generalizability for young women in resource-limited settings.
