The purpose of the study is to determine whether oral contraceptives, desmopressin acetate, and/or tranexamic acid are effective in the treatment of women with menorrhagia who are diagnosed with a bleeding disorder.

Condition	Treatment or Intervention
Menorrhagia Blood Coagulation Disorders Blood Platelet Disorders von Willebrand Disease Hematologic Disease	Drug: Tranexamic Acid  Drug: Desmopressin Acetate

Further Study Details: 

Primary Outcomes: Reduction of menstrual blood loss as measured by a Pictorial Self-Assessment Chart; Changes in quality of life
Expected Total Enrollment:  100

Menorrhagia is a common clinical problem. Morbid events include dysmenorrhea, hospitalizations, red blood cell transfusions, and quality of life impairment in terms of daily activities, chronic pain, and time lost from work and or school. Up to 60% of women with uncontrolled menorrhagia undergo hysterectomy. Up to 20% of women with menorrhagia may have undiagnosed von Willebrand disease (vWd), or other bleeding disorders. Prevalence of vWd in the general population is estimated at just over 1%. Intuitively, the prevalence of vWd in women with menorrhagia is probably higher since platelet plug formation is necessary for menstrual hemostasis. Current management of menorrhagia in patients in the United States often begins with hormonal therapy. Estrogen and estrogen derivatives in oral contraceptives have been shown to increase von Willebrand factor (vWf) levels. Women with menorrhagia who have vWd or who are hemophilia A carriers have also been successfully treated with desmopressin acetate (DDAVP, Stimate® Nasal Spray). Tranexamic acid (Cyklokapron) is utilized extensively for menorrhagia in Australia and the United Kingdom. Standard hormonal therapy has not been compared with desmopressin or antifibrinolytics for menorrhagia. This study will compare treatment options for women with menorrhagia who have a detectable bleeding disorder. Investigators will document the effect on quality of life, menstrual flow, and coagulation parameters of treatment with oral contraceptive pills, desmopressin, or tranexamic acid.

Ages Eligible for Study:  18 Years   -   50 Years,  Genders Eligible for Study:  Female

Criteria

Inclusion Criteria:

• Referred to study by gynecologist or internist/family practitioner with diagnosis of menorrhagia or referred by self through community advertising or networking
• Prospective pictorial chart scores of menses >100
• Negative pelvic exam and Pap smear within the past year. *Ultrasound if manual exam indicates abnormal uterine size; *Endometrial biopsy if >35 and non-cyclic bleeding; *Rule out acute pelvic diseases – gonorrhea, chlamydia
• Age 18-50
• Willing to go off oral contraceptives and selected drugs (including some nutritional supplements and drugs that affect coagulation such as aspirin and ibuprofen) for initial laboratory testing and throughout the cross-over drug portion of the study
• Periods at least every 39 days

Exclusion Criteria:

• Patient is not proficient in English
• Patient is pregnant
• Patient on hormone replacement, Depo-Provera, or Norplant in last three months
• Patient has intrauterine device (IUD) present
• Patient is taking warfarin sodium (Coumadin) or other anti-coagulation therapy
• History of documented vascular disease (coronary artery disease, cerebrovascular disease or stroke, transient ischemic attack, peripheral vascular disease)
• Uncontrolled hypertension
• Insulin dependent diabetes mellitus
• Chronic renal or liver disease
• History of seizure disorder
• History of cancer (other than non-invasive skin cancer)
• History of venous or arterial thromboembolism
• Patient with a previously diagnosed bleeding disorder has taken or is taking desmopressin acetate or antifibrinolytic drugs for treatment of heavy menstrual bleeding

Please refer to this study by ClinicalTrials.gov identifier  NCT00111215

Nicole F. Dowling, Ph.D.      404-498-2814    ndowling@cdc.gov
Sally Crudder, BSN      404-498-2718    scrudder@cdc.gov

Georgia
      Emory University School of Medicine, Atlanta,  Georgia,  30303,  United States; Recruiting
Michigan
      Michigan State University, East Lansing,  Michigan,  48864,  United States; Recruiting
Minnesota
      The Mayo Clinic, Rochester,  Minnesota,  55905,  United States; Recruiting
New Jersey
      UMDNJ Robert Wood Johnson Medical School, New Brunswick,  New Jersey,  08903,  United States; Recruiting
New York
      Mary M. Gooley Hemophilia Center, Rochester,  New York,  14621,  United States; Recruiting
North Carolina
      Duke University Medical Center, Durham,  North Carolina,  27710,  United States; Recruiting

Study ID Numbers:  CDC-NCBDDD-2906
Record last reviewed:  May 2005
Last Updated:  May 18, 2005
Record first received:  May 18, 2005
ClinicalTrials.gov Identifier:  NCT00111215
Health Authority: United States: Food and Drug Administration
ClinicalTrials.gov processed this record on 2005-05-24