Heavy Menstrual Bleeding Progestin Treatment in Bleeding Disorders Study

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

300 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-09-24

Study Completion Date

2029-06-30

Brief Summary

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The goal of this multicenter prospective observational study and registry of U.S. adolescents and young adults with heritable bleeding disorders is to determine the bleeding outcomes, satisfaction, hemostatic parameter changes, and patient reported quality of life after 6 months of use of either of two commonly used hormonal treatments for menstrual suppression - levonorgestrel intrauterine device (LNG-IUD) and norethindrone acetate (NETA). Under this application the study will compare the two treatments and compare outcomes after LNG-IUD treatment results to a control group without a bleeding disorder, with the goal of determining the benefits and expected outcomes of these treatment options for this population.

Detailed Description

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Heavy menstrual bleeding (HMB) is common among adolescents and young adults with an inherited bleeding disorder (BD) and negatively impacts health-related quality of life and physical and mental health status. Effective treatment options are available that decrease bleeding and improve quality of life, but were not studied in those with BD, so investigators do not know if there is similar effectiveness in this condition. The impact of treatment on diagnostic testing for BD or on improvement of iron deficiency is also not known. Given these gaps in knowledge, the primary objective of the Heavy Menstrual Bleeding Progestin Treatment in Bleeding Disorders Study is to conduct a multicenter prospective observational cohort study and registry, enrolling adolescents and young adults with heavy menstrual bleeding cared for at collaborating interdisciplinary menstrual clinic sites nationally who are choosing to start use of either of two commonly used progestin menstrual treatment options: levonorgestrel-releasing intrauterine system (LNG-IUD) or oral norethindrone acetate 5 mg daily (NETA) (N=300). In Aim 1, the study will compare outcomes related to (a) bleeding management, (b) quality of life, and (c) repletion of iron storage levels after six months of treatment with either option in those with a diagnosed inherited bleeding disorder. The primary outcome will be treatment success with a Pictorial Blood Loss Assessment Chart (PBAC) score \<50 points by six months. Secondary objectives to assess bleeding management will include need for adjuvant management, change in PBAC from baseline to 6 months, and self-reported treatment success. Quality of life outcomes will include change in validated scales to assess health-related quality of life which are specific to adolescents and young adults in the setting of heavy menstrual bleeding. The study will compare ferritin levels at six months compared to baseline to determine the relative amount of benefit obtained from either treatment option. In Aim 2, the study will compare outcomes after LNG-IUD in those with and without a bleeding disorder, assessing rates of expulsion and method continuation between the two groups in addition to the outcomes assessed for Aim 1. Aim 3 will improve our understanding of the impact of physiological stress on BD diagnostic studies by comparing change in hemostatic parameters before and after successful treatment in those with HMB without a previously diagnosed bleeding disorder. This study will demonstrate the relative benefits of menstrual suppression treatment options for adolescents and young adults with heavy menstrual bleeding and inherited bleeding disorders, will provide population-specific estimates for expected benefit that can be used in treatment counseling, and will highlight the impact of treatment status on diagnostic test results.

Conditions

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Heavy Menstrual Bleeding Bleeding Disorder Von Willebrand Diseases

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Bleeding disorder using LNG-IUD

Adolescents and young adults ages 10-24 with diagnosed bleeding disorder planning use of LNG-IUD.

Levonorgestrel Intrauterine System

Intervention Type DRUG

52 mg levonorgestrel intrauterine system

Non-bleeding disorder using LNG-IUD

Adolescents and young adults ages 10-24 without diagnosed bleeding disorder planning use of LNG-IUD.

Levonorgestrel Intrauterine System

Intervention Type DRUG

52 mg levonorgestrel intrauterine system

Bleeding disorder using NETA

Adolescents and young adults ages 10-24 with diagnosed bleeding disorder planning use of NETA.

Norethindrone Acetate

Intervention Type DRUG

norethindrone acetate 5 mg daily

Interventions

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Levonorgestrel Intrauterine System

52 mg levonorgestrel intrauterine system

Intervention Type DRUG

Norethindrone Acetate

norethindrone acetate 5 mg daily

Intervention Type DRUG

Other Intervention Names

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Mirena Liletta Aygestin

Eligibility Criteria

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Inclusion Criteria

* Post-menarcheal
* Ages 10-24
* Decision to initiate a trial of progestin therapy with either LNG-IUD or NETA
* Able to provide assent and written informed consent by one parent (ages \<18) or written informed consent (age 18+)
* Must meet trial criteria for heavy menstrual bleeding
* Must meet trial criteria for a bleeding disorder or have minimum workup to rule out bleeding disorder

Exclusion Criteria

* Pregnant or seeking pregnancy

Minimum Eligible Age

10 Years

Maximum Eligible Age

24 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Responsible Party

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Maureen Baldwin

Associate Professor of Ob/Gyn

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maureen Baldwin, MD MPH

Role: PRINCIPAL_INVESTIGATOR

Oregon Health and Science University

Allison Wheeler

Role: PRINCIPAL_INVESTIGATOR

University of Washington

Locations

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