What is the interaction between Tranexamic acid (TXA) and birth control pills?

From the Guidelines

Tranexamic acid can be safely taken with birth control pills, as there is no significant interaction between these medications that would reduce the effectiveness of either one or cause harmful side effects. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1, tranexamic acid is listed as a treatment option for bleeding irregularities in women using combined hormonal contraceptives (CHC). The recommendations suggest that antifibrinolytic agents, such as tranexamic acid, can be used for 5 days to treat spotting, light bleeding, or heavy/prolonged bleeding in CHC users.

Key Points to Consider

• Tranexamic acid works by preventing blood clots from breaking down, which helps reduce heavy menstrual bleeding.
• Birth control pills contain hormones (estrogen and/or progestin) that regulate the menstrual cycle and prevent pregnancy.
• The standard dosage for tranexamic acid for menstrual bleeding is typically 1300 mg taken three times daily for up to 5 days during menstruation, as stated in the example answer, but it's essential to follow the healthcare provider's specific instructions.
• If a patient experiences unusual side effects while taking these medications together, they should contact their healthcare provider promptly.

Treatment Options

The U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1 also lists other treatment options for bleeding irregularities, including:

• Hormonal treatment (e.g., 20–30 μg ethinylestradiol [EE] combined oral contraceptives [COCs] or estrogen)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., celecoxib, ibuprofen, or mefenamic acid), 5–7 days
• Selective estrogen receptor modulators (SERMs) (e.g., tamoxifen), 7–10 days

However, tranexamic acid is a viable option for women experiencing heavy menstrual bleeding while using birth control pills, and its use is supported by the most recent and highest-quality study 1.

From the FDA Drug Label

Advise patients using hormonal contraception that combined use with Tranexamic acid may increase the risk for thromboembolic adverse reactions and to use effective alternative (nonhormonal) contraception during therapy with Tranexamic acid [see Warnings and Precautions (5.1), Drug Interactions (7.1), Use in Specific Populations (8. 3)]. The use of tranexamic acid with hormonal birth control pills may increase the risk of thromboembolic adverse reactions. It is recommended to use effective alternative (nonhormonal) contraception during therapy with tranexamic acid 2, 2, 2.

• Key points:
  • Increased risk of thromboembolic adverse reactions
  • Use of hormonal contraception with tranexamic acid
  • Recommendation for alternative nonhormonal contraception
• Main idea: Tranexamic acid and hormonal birth control pills may have a potentially harmful interaction.

From the Research

Tranexamic Acid and Birth Control Pills

• Tranexamic acid and combined oral contraceptives (COCs) are equally effective in reducing heavy menstrual bleeding, with no significant difference in efficacy between the two treatments 3.
• However, in patients with leiomyomas, COCs were found to be more effective than tranexamic acid in reducing menstrual blood loss 3.
• COCs, which contain estrogen and progestin, increase the risk of venous thromboembolism (VTE), with newer COCs containing desogestrel, drospirenone, or gestodene having a higher risk than older COCs 4.
• Progestin-only hormonal contraception, on the other hand, is not associated with a significant increase in VTE risk, making it a safer option for women at high risk of thrombosis 4, 5.
• Tranexamic acid is generally well-tolerated, with most adverse reactions being mild or moderate, but high doses have been associated with seizures and other adverse effects 6.
• The use of tranexamic acid and COCs may have different implications for women with certain medical conditions, such as thrombophilia or a history of VTE, and should be carefully considered by physicians 3, 4, 5.

Comparison of Tranexamic Acid and COCs

• Both tranexamic acid and COCs are effective in reducing heavy menstrual bleeding, but may have different side effect profiles and risks 3, 6.
• COCs may be more effective in patients with leiomyomas, but increase the risk of VTE, particularly in women with a history of thrombosis or thrombophilia 3, 4.
• Progestin-only contraception, including progestin-only pills and intrauterine devices, may be a safer alternative for women at high risk of thrombosis 4, 5.
• The choice of treatment should be individualized based on a woman's medical history, risk factors, and personal preferences 3, 5.

Safety and Efficacy

• Tranexamic acid is generally safe and effective in reducing heavy menstrual bleeding, but may have adverse effects at high doses 6.
• COCs are effective in reducing heavy menstrual bleeding, but increase the risk of VTE and may have other side effects 3, 4.
• Progestin-only contraception is a safe and effective alternative for women at high risk of thrombosis, but may be associated with unscheduled bleeding and spotting 4, 5, 7.