Tranexamic Acid as Treatment for Nonstructural Abnormal Uterine Bleeding in Reproductive-Age Women: A Systematic Review and Meta-Analysis [ID 1309]

INTRODUCTION: Abnormal uterine bleeding (AUB) is a common gynecological condition, with nonstructural causes accounting for 38.9% cases in the reproductive-age population. Tranexamic acid (TXA) offers a nonsurgical, nonhormonal treatment option for managing this condition, but has limited evidence in nonstructural disease. This systematic review (SR) and meta-analysis (MA) aims to assess the effectiveness and safety of TXA for nonstructural AUB in reproductive-age patients. METHODS: A systematic search was conducted across six electronic databases. Eligible studies included randomized controlled trials, crossover trials, cohort studies, and case–control studies involving women aged 18–50 years with nonstructural AUB. Primary outcomes included changes in menstrual blood loss (MBL), hemoglobin (HB) levels, and the incidence of adverse events (AE). Meta-analyses were conducted using random-effects models, and risk of bias was assessed using the Cochrane ROB2 tool. RESULTS: Eleven studies were included in the SR, and nine met criteria for MA. Tranexamic acid was associated with a statistically significant reduction in MBL compared to control interventions (mean difference [MD] −112.52 mL; 95% CI, −141.58 to −83.46; P <.01; I 2 =36.3%). No significant change in HB levels was observed (MD −0.03; 95% CI, −0.22 to 0.15; P 0.69; I 2 =0%). The risk of AE did not differ significantly between TXA and comparator groups (risk ratio [RR]=1.43; 95% CI, 0.74–2.73; P 0.27; I 2 =66.9%). CONCLUSIONS/IMPLICATIONS: Tranexamic acid demonstrates a favorable safety profile and statistically significant efficacy in reducing MBL in women with nonstructural AUB. Further high-quality studies are needed to optimize treatment recommendations.