From the Research
For a 36-year-old woman with heavy vaginal bleeding due to a large fibroid, the recommended dose of tranexamic acid is 1,000 mg (1 gram) taken orally three times daily for up to 5 days during menstruation. This recommendation is based on the most recent and highest quality evidence available, which prioritizes the reduction of morbidity, mortality, and improvement of quality of life 1.
Key Considerations
- Treatment should begin when heavy bleeding starts and continue only during the bleeding episode.
- The maximum daily dose should not exceed 4 grams.
- Tranexamic acid works by inhibiting fibrinolysis, which helps blood clots remain stable and reduces bleeding.
- This medication is particularly effective for managing acute heavy menstrual bleeding while more definitive treatments for the fibroid are being considered.
Important Precautions
- Before starting treatment, ensure the patient has no history of thromboembolic disorders, active intravascular clotting, or hypersensitivity to tranexamic acid, as these are contraindications.
- Common side effects include nausea, vomiting, and diarrhea.
- While tranexamic acid can effectively manage bleeding symptoms, it does not treat the underlying fibroid, so the patient should be referred for gynecological evaluation to discuss long-term management options such as hormonal therapy, uterine artery embolization, or surgical interventions depending on her fertility desires and symptom severity.
Long-Term Management
- The use of gonadotropin-releasing hormone analogues (GnRHa) and selective progesterone receptor modulators (SPRMs) may be considered for preoperative medical therapy to reduce uterine and fibroid volume and increase preoperative haemoglobin levels 2.
- However, the choice of treatment should be individualized based on the patient's symptoms, fertility desires, and overall health status.
- It is essential to weigh the benefits and risks of each treatment option and involve the patient in the decision-making process to ensure the best possible outcome.