From the Research
For a 45-year-old hypertensive patient on hydrochlorothiazide experiencing heavy bleeding, tranexamic acid (TXA) is indeed a safer option than hormone therapy. I recommend prescribing tranexamic acid 1300 mg orally three times daily for up to 5 days during menstruation, as supported by the most recent and highest quality study 1. This medication works by inhibiting fibrinolysis, thereby reducing menstrual blood loss without affecting blood pressure or increasing thrombotic risk significantly. For this patient, hormone therapy poses additional concerns due to her age and hypertension, which together increase her cardiovascular and thrombotic risk, as noted in various studies 2, 3, 4. TXA is non-hormonal and doesn't interact with her antihypertensive medication. Before starting treatment, confirm there's no history of thromboembolic disorders, and advise the patient that mild side effects may include nausea, headache, or back pain. If bleeding remains uncontrolled after 2-3 cycles of TXA, further evaluation for underlying gynecological conditions would be warranted. Additionally, monitor her blood pressure regularly as heavy menstrual bleeding could potentially lead to anemia, which might affect blood pressure control. Some studies have raised concerns about the risk of thrombosis with TXA use 5, but the overall evidence suggests that TXA is a safe and effective option for heavy menstrual bleeding, especially when compared to hormone therapy. Key points to consider when prescribing TXA include:
- Starting dose and duration of treatment
- Potential side effects and interactions
- Monitoring for underlying gynecological conditions
- Regular blood pressure checks to prevent anemia and its effects on blood pressure control. Overall, TXA is a viable option for managing heavy menstrual bleeding in hypertensive patients, and its use should be considered on a case-by-case basis, taking into account the patient's individual risk factors and medical history, as recommended by recent studies 2, 1.