The Women’s Health Strategy for England states women have been told that heavy and painful periods are ‘normal’ and they will ‘grow out of them’.1
This ‘normalisation’ of heavy menstrual bleeding (HMB), or menorrhagia, means patients may live with symptoms for several years before seeking healthcare professional advice.2
Add to this a lack of awareness that HMB can be treated,2 and it is clear that there is a role for pharmacy to step in and act as a source of advice for those living with HMB.
The impact of HMB
HMB is a common gynaecological problem affecting between 5–30% of women of reproductive age3 and is the underlying reason for 12% of all gynaecology referrals.4
It has a significant impact on a woman’s quality of life causing physical, social, and emotional consequences.4 Generally, menstrual bleeding is the main cause of iron deficiency anaemia among reproductive women, adding to the symptom burden for those affected.5
Many women live with the impact of HMB for several years before seeking help2, further complicated by some women feeling a social pressure to hide their symptoms in the belief that it is a taboo subject.2
HMB also exerts a significant burden on primary care, with 1 in 20 sufferers aged 30–49 years seeking GP advice annually for HMB or menstrual problems.4
The burden in younger patients may be even higher, as HMB is estimated to affect up to 37% of adolescents,6 who may not be consulting any healthcare professional for advice.
Help from pharmacy teams
Being able to offer advice and guidance on effective treatment is vital for sufferers, and pharmacists and staff are often the first to notice that a customer might need help with HMB.
“As a mother of three daughters myself I’m well aware of the negative impact HMB has on our younger demographic of girls and women, who change their routine to accommodate their discomfort”, says community pharmacist Sukhi Basra. “HMB is often passed off as being ‘normal’ and something they will ‘grow out of’, but stopping things like sports, dance and other activities that they otherwise enjoy impacts their self esteem, confidence and curiosity in life, so it is important for pharmacists to spot customers who may be trying to manage symptoms silently.
“Buying large volumes of sanitary products or doubling up on types of sanitary products could act as a cue to open a conversation with a customer about HMB, and menstrual pain is another prominent symptom1, so people seeking strong analgesics for this indication could also be asked about HMB and its impact on their life. After all, women tend to tolerate many things, but if we have a solution we should empower people to utilise products available to help them.”
The benefits of tranexamic acid
Women with HMB have been found to have increased fibrinolytic activity in their menstrual blood.7,8 This causes accelerated degradation of the fibrin clot that forms to induce haemostasis.8 This increased fibrinolytic activity results in increased blood loss when the endometrium is shed during menstruation.8
The anti-fibrinolytic tranexamic acid is recommended by NICE as a first-line non-hormonal treatment option for HMB.4
Tranexamic acid reversibly blocks lysine binding sites on plasminogen, which prevents plasmin interacting with lysine residues on the fibrin polymer.
This blocking results in a deceleration in subsequent fibrin degradation, leading to a slowing in clot dissolution and, therefore, menstrual bleeding.9,7
Evana® Heavy Period Relief 500 mg Tablets
With the launch of Maxwellia’s Pharmacy-only medicine Evana® Heavy Period Relief 500 mg tablets, containing the antifibrinolytic tranexamic acid10, the pharmacy team is also able to provide an effective, NICE-recommended first-line non-hormonal treatment option for HMB management.4
The active ingredient in Evana® Heavy Period Relief 500 mg tablets has been shown to not only reduce menstrual bleeding by up to 60%11 but also to improve quality of life by up to 83%,9 meaning pharmacists can make a real and valuable difference to the lives of their HMB patients*.
Most women will see a significant reduction in HMB within the first cycle of use12, although for a small proportion it may take several cycles for Evana to significantly reduce HMB.10,12 For example, in one open, non-controlled study of 825 women with heavy menstrual bleeding, after the first cycle of tranexamic acid use, 87% of women perceived a decreased or strongly decreased volume of menstrual bleeding, rising to 94% of users after the third cycle of use.12
Maxwellia’s menstrual health range
Evana® Heavy Period Relief Tablets 500 mg Tranexamic Acid for heavy menstrual bleeding, are part of Maxwellia’s menstrual health range which also includes Ultravana® Period Pain Relief Tablets 250 mg Naproxen for the treatment of dysmenorrhoea (period pain).
Women’s health champion Maxwellia has launched these medicines in response to a current unmet need where ‘normalisation’ of periods means many women are struggling with disruptive symptoms each month and are not seeking advice and treatment from a healthcare professional.
The only pharmacy brand available for the relief of heavy menstrual bleeding, Evana® can be used in women aged 18 to 45 years. Ultravana® is indicated for the relief of primary dysmenorrhea (period pain) in women aged 15 to 50 years. The products can also be used simultaneously if women experience both HMB and period pain.
Evana® is available in UK pharmacies from August 2024 at a recommended retail price of £14.95 per pack of 18 tablets, and Ultravana® is available with a retail price of £5.95 per pack of 9 tablets.
Pharmacy training on menstrual health products
Maxwellia has developed an online portal to help pharmacists and their teams conduct effective, patient-specific, clinical consultations on heavy menstrual bleeding, and appropriately supply Evana® Heavy Period Relief 500 mg tablets (tranexamic acid) to women who are eligible.
Pharmacist and pharmacy teams can find out more by visiting the Evana® and Ultravana® HCP portal at www.evanaperiods.com/hcp
“Many women still don’t know that they do not have to suffer in silence and that there are treatments available to help with heavy menstrual bleeding”, says Maxwellia founder and CEO Anna Maxwell.
“Heavy and painful periods are common, but they shouldn’t be disruptive. Widening access to these medicines so they can be bought from a pharmacy will result in increased awareness of the condition and let women know that there are treatment options available, with the aim of drawing them in to talk to their pharmacist and potentially enabling an earlier intervention than would normally happen under the present system.
“This is another momentous step on our journey in enabling pharmacists to broaden their front-line role. I know that pharmacists and their teams can play an even greater role in helping women take more control of their own health. Together, we can spread the word, encourage women to talk about their experiences, and take practical steps to help themselves.”
* Please be aware that HMB may also affect patients assigned female at birth (AFAB).
Further information:
For more information about Maxwellia visit www.maxwellia.com
References
1.Women’s Health Strategy for England. August 2022. Available at: https://www.gov.uk/government/publications/womenshealth-strategy-for-england/womens-health-strategy-for-england.
2. Dutton, B, & Kai, J. Women’s experience of heavy menstrual bleeding and medical treatment: a qualitative study in primary care. Br J Gen Pract. 2023; DOI:https://doi.org/10.3399/BJGP.2022.0460.
3. Cox, M, et al. The delivery of heavy menstrual bleeding services in England and Wales after publication of national guidelines: a survey of hospitals. BMC Health Services Res. 2013; 13:491.
4. NICE. Heavy menstrual bleeding: assessment and management. Guidance 88. Published March 2018. Updated May 2021. Available at:https://www.nice.org.uk/guidance/ng88.
5. NICE. Clinical Knowledge Summaries. Anaemia – iron deficiency. Last revised April 2023. Accessed October 2023. Available at: https://cks.nice.org.uk/topics/anaemia-iron-deficiency/
6. NICE Clinical Knowledge Summaries. Menorrhagia (heavy menstrual bleeding). Last revised March 2023. Accessed October 2023. Available at: https://cks.nice.org.uk/topics/menorrhagia-heavy-menstrual-bleeding/.
7. Bryant-Smith, AC, et al. Antifibrinolytics for heavy menstrual bleeding (review). Cochrane Database of Systematic Reviews. 2018, Issue 4. Art. No.: CD000249.
8. Maybin, JA, & Critchley, HOD. Medical management of heavy menstrual bleeding. Women’s Health. 2016;12(1):27–34.
9. Naoulou, B, & Tsai, MC. Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand. 2012; 91:529–537.
10. Evana® Heavy Period Relief 500 mg Tablets. Summary of Product Characteristics. Available at https://evanaperiods.com/hcp/evana/spc
11. Leminen, H, & Hurskainen, R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Women’s Health. 2012; 4:413–421.
12. Winkler, UH. The effect of tranexamic acid on the quality of life of women with heavy menstrual bleeding. EJOG. 2001;99(2):238-243.
Essential Information
Evana Heavy Period Relief 500 mg tablets (Tranexamic acid). Reduction of heavy menstrual bleeding over several cycles in women with regular, 21-35-day cycles with no more than 3 days variation.
Ultravana Period Pain Relief 250 mg Gastro-resistant tablets (Naproxen). For the treatment of primary dysmenorrhoea in women aged 15-50 years.
Maxwellia Ltd., Alderley Park, Alderley Edge, Cheshire, SK10 4TG. Supply classification: P.
Information about these products, including adverse reactions, precautions, contraindications, and method of use can be found at: evanaperiods.com/hcp/.
Source
evana-pharmacy-training-guide-1.pdf (evanaperiods.com)
Evana Healthcare Professional Training (evanaperiods.com)
Contact
Pharmacist and NPA Board Member
sukhibasra73@yahoo.co.uk