Effects of antiplatelet therapy on menstrual blood loss in reproductive-aged women: a systematic review

Abstract

Background: The effects of antiplatelet therapy on menstrual bleeding have not been well characterized.

Objectives: To systematically review the effects of antiplatelet therapy on menstrual bleeding.

Methods: A literature search was performed for studies of reproductive-aged women who received antiplatelet therapy. Characteristics of menstrual bleeding both before and after initiation of antiplatelet therapy and from comparison groups were collected. Two reviewers independently assessed the risk of bias in individual studies.

Results: Thirteen studies with a total of 611 women who received antiplatelet therapy were included. Types of antiplatelet drugs used were aspirin (n = 8), aspirin and/or clopidogrel (n = 2), prasugrel (n = 1), and not specified (n = 2). Risk of bias was assessed at moderate (n = 1), serious (n = 8), critical (n = 2), and no information (n = 2). Three studies reported changes in menstrual blood loss volume. One of these showed no increase during antiplatelet therapy; the other 2 studies suggested that aspirin may increase menstrual blood loss volume. In 3 studies that assessed the duration of menstrual bleeding, up to 13% of women reported an increased duration of menstruation. In 5 studies that reported the intensity of menstrual flow, 13% to 38% of women experienced an increase in the intensity of flow. Five studies reported the prevalence of heavy menstrual bleeding in women who received antiplatelet therapy, with estimates ranging from 7% to 38%.

Conclusion: There is lack of high-quality data on the effects of antiplatelet therapy on menstrual bleeding. Aspirin may increase menstrual blood loss, at least in a minority of women, whereas the effects of P2Y12 inhibitors are unknown.

Keywords: aspirin; clopidogrel; menorrhagia; platelet aggregation inhibitors; systematic review.

Figure 1

Flow diagram of the study selection process. ∗Systematic review (SR) of the studies that were already included. This figure was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram [21].

Figure 2

Risk of bias judgment. Both domain-level and overall risk of bias judgments for all included studies. This figure was created with the robvis tool [35].