WOMAN-3

World-wide, half a billion women of reproductive age are anaemic. Anaemia is a particular problem during pregnancy and poses a serious risk to both mothers and their babies. Anaemia increases the risk of antepartum haemorrhage, prematurity, stillbirth, neonatal death, postpartum haemorrhage and maternal death. It is therefore best to treat anaemia in young women well before they get pregnant.

Although iron and multivitamin replacement is a common anaemia treatment, iron levels in young women depend more on menstrual iron loss than on dietary intake.  Heavy menstrual bleeding has so far been overlooked in the search for new strategies to treat anaemia.

While it is well known that bleeding causes anaemia, evidence also shows that anaemia worsens bleeding. Because anaemia worsens bleeding, women with anaemia have heavier periods than they would if they were not anaemic. For these reasons, offering iron replacement without reducing menstrual iron loss may be inefficient.

The drug tranexamic acid (TXA) reduces menstrual bleeding by preventing blood clot breakdown. The WOMAN-3 Trial will investigate whether giving TXA with iron and vitamin replacement will be more effective in treating anaemia than iron and vitamin replacement alone.