Kouides 2009.

Methods	A randomised cross‐over study.
Participants	116 recruited. Inclusion criteria: women having a lab detectable bleeding disorder, a MBL amounting to more than 100 mL per bleed, a negative pelvic examination (though women with fibroids with the uterus was < 12 weeks gestational size were included), a negative PAP smear within the last 12 months, having regular periods and not on any medications that might affect coagulation. Participants gave written consent. Exclusion criteria: women having a blood loss of < 100 mL per cycle. Women having no laboratory detectable bleeding disorder.
Interventions	One group received IN‐DDAVP first for 2 menstrual cycles and subsequently received tranexamic acid for 2 menstrual cycles, and the other group received tranexamic acid first followed by IN‐DDAVP. There was no washout period in between washout. Intranasal DDAVP 300 lg, was administered on days 2 and 3 of menstrual bleeding (1 puff in each nostril each day) Trenaxamic acid was administered in tablet form at a dosage of 1 g 4 times each day for the first 5 days of menstrual bleeding.
Outcomes	1. Menstraul blood loss PBAC was the method used 2. QoL 3. Adverse effects
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Described as randomised, but no information on the method used.
Allocation concealment (selection bias)	Unclear risk	Allocation concealment was not reported.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Blinding not carried out but as the primary outcome is objective, this does not cause bias.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinding not carried out but as the primary outcome is objective, this does not cause bias.
Incomplete outcome data (attrition bias) All outcomes	High risk	A high dropout rate (43% for the IN‐DDAVP to tranexamic acid sequence and 33% for the tranexamic acid to IN‐DDAVP sequence). Paper did state "However, comparisons by sequence of the demographic characteristics, race and diagnosis, by attrition, sequence and treatment yielded minimal differences".
Selective reporting (reporting bias)	Low risk	All outcomes reported.
Other bias	Unclear risk	No mention of pharmaceutical funding or other potential sources of bias.

IN‐DDAVP: intranasal desmopressin
 INR:international normalised ratio
 MBL: menstrual blood loss
 PAP: Papanikolaou smear
 PBAC: pictorial blood assessment chart
 QoL: quality of life