Role of a non-hormonal oral anti-fibrinolytic hemostatic agent (tranexamic acid) for management of patients with dysfunctional uterine bleeding.

OBJECTIVE: Perimenaposal dysfunctional bleeding is a common complaint seen in gynecology clinics. Tranexamic acid is a cheap, over the counter hemostatic agent with antifibrinolytic activity that can be used for management of excessive menstrual bleeding. However, there are few reports analyzing its effectiveness in the management of abnormal menstrual bleeding. This study aimed to evaluate the effectiveness of oral transexamic acid treatment in patients with excessive dysfunctional perimenopausal menorrhagia. METHOD: One hundred and thirty-two consecutive patients with dysfunctional perimenepausal uterine bleeding who were admitted to Cankiri Government Hospital between March 2007 and January 2008 were prospectively enrolled into this one-sided study. All the patients were asked to fill out menstrual diaries and to come to follow-up three months after the initial evaluation. All patients took 500 mg of transexamic acid (Transamine 3x2) during their menses as the primary treatment and iron preparations if Hb was < 10 g/dl. The paired sample t-test was used for statistical evaluation. RESULTS: Mean age of the patients was 42.8 (range 38-46 yrs). Median bleeding time was nine days (range 8-12 days) and median Hb was 10.6 g/dl (range 8.2-11.7) before starting the treatment. During follow-up 45 patients were unresponsive to transamine and needed further treatments (overall response rate was 65.9%). Among responsive patients, after three cycles of transamine usage median bleeding time was five days (range 3-8 days) and median Hb values were 12.1 g/dl. CONCLUSION: Oral tranexamic acid is a reasonable treatment option for patients with excessive dysfunctional perimenopousal bleeding with a 66.0% response rate.

Interval debulking in epithelial ovarian carcinomas: the past, present and the future.

Primary cytoreductive surgery followed by combination chemotherapy of paclitaxel and cisplatinum is the standard treatment for advanced staged epithelial ovarian cancers. Despite the maximal efforts to increase optimal cytoreductive success rates and related ultra-radical surgeries, five-year survival rates are still poor. Primary cytoreductive surgeries and their radicalities have been criticized since the early nineties. Interval debulking surgery (IDS) and neo-adjuvant chemotherapy (NAC) are the two suggested alternatives to the primary debulking approaches. In this article, the authors summarize and discuss the IDS approach with an associated literature review.