WEHI & icddr,b Trial: TXA for Heavy Menstrual Bleeding & Anaemia in Bangladesh | Dr Eliza Davidson

Heavy menstrual bleeding (HMB), a common gynecological condition, significantly impacts quality of life for women. While various medical treatments exist, a new clinical trial launching in early 2026 aims to evaluate the effectiveness of tranexamic acid (TXA) in reducing HMB, particularly in adolescent girls in low- and middle-income countries. The trial, a collaboration between the Walter and Eliza Hall Institute of Medical Research (WEHI) in Australia and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), seeks to address a historically overlooked area of global health research.

According to Dr. Eliza Davidson, a senior research officer at WEHI’s Anaemia Research Lab, HMB can affect up to half of all women in low- and middle-income countries, contributing to anemia and disrupting education, especially for young women. “Heavy menstrual bleeding has been overlooked in global health research,” Dr. Davidson explained. “It drives anaemia and disrupts education, especially for young women.”

The upcoming trial will randomize girls aged 15 to 17 with HMB to receive either TXA or a placebo, following them for 12 months. Researchers will measure hemoglobin levels and quality of life to assess the impact of TXA. TXA is considered a potentially advantageous treatment option because, unlike hormonal contraceptives, it directly reduces bleeding without hormonal side effects, making it a culturally appropriate solution in some settings.

The partnership between WEHI and icddr,b is central to the success of this research. Dr. Davidson highlighted the complementary strengths of the two institutions. “The icddr,b team are experts in running complex studies in challenging settings, while WEHI brings strengths in trial design, epidemiology, and analysis. Together, we achieve what we couldn’t do alone.” This collaboration builds on a decade-long relationship focused on resilience and cultural sensitivity.

The choice to focus on TXA stems from its potential to offer a direct solution to HMB. A recent study published in February 2025 (as referenced by PubMed data) demonstrated that medical management of HMB is generally effective in reducing menstrual blood loss and improving hemoglobin levels. The study, conducted at a tertiary care institute in Central India between February 2023 and July 2024, included 240 women and evaluated several medical management options, including levonorgestrel intrauterine systems (LNG-IUS), tranexamic acid, norethisterone, injectable depot medroxyprogesterone acetate (inj DMPA), and combined oral contraceptive pills (COCP). While LNG-IUS showed the highest reduction in bleeding at six months (93%), all five groups experienced significant reductions in blood loss.

The Indian study found varying degrees of reduction in Pictorial Blood Loss Assessment Chart (PBAC) scores across the different treatments. Baseline median PBAC scores ranged from 380 (COCP) to 690 (inj DMPA). The greatest reduction at three months was observed with inj DMPA (78%), while LNG-IUS demonstrated the most substantial reduction at six months. Importantly, all groups showed statistically significant improvements in hemoglobin levels over the six-month study period.

However, the WEHI/icddr,b trial specifically targets adolescent girls in a low- and middle-income country setting, a population often underrepresented in HMB research. This focus acknowledges the unique challenges faced by this demographic, where HMB can significantly impede educational attainment and overall well-being.

The logistical complexities of conducting research in Bangladesh are acknowledged by Dr. Davidson, who noted that the partnership has navigated challenges such as supply shortages and dengue outbreaks. Despite these hurdles, the team has consistently delivered high-quality research. A key component of the collaboration also involves strengthening local capacity through training in statistical analysis and research methods.

The research builds on existing work exploring anemia and women’s health. The Gates Foundation has funded several initiatives related to maternal and child health in Bangladesh, including research into microbiome-directed therapeutic foods for malnourished children. While not directly related to HMB, these investments demonstrate a broader commitment to improving health outcomes for women and children in low-resource settings.

The results of the TXA trial are anticipated to provide valuable insights into a cost-effective and accessible treatment option for HMB, potentially improving the lives of millions of women and girls worldwide. The study’s emphasis on cultural sensitivity and local capacity building underscores a commitment to sustainable and equitable healthcare solutions.