From the Guidelines
For abnormal uterine bleeding, the recommended dose of tranexamic acid (TXA) is typically 1,000-1,300 mg taken orally three times daily for 3-5 days during menstruation, starting when bleeding begins. This regimen can be repeated each menstrual cycle as needed. TXA works by inhibiting plasminogen activation, which reduces fibrinolysis and helps stabilize blood clots, thereby decreasing menstrual blood loss by approximately 40-60% 1. For patients with heavier bleeding, treatment may be extended to 7 days if necessary. The medication should be taken only during menstruation and not continuously. Common side effects include nausea, diarrhea, and headache. TXA is contraindicated in women with active thromboembolic disease, history of thrombosis, or severe renal impairment. It can be used alongside hormonal treatments like oral contraceptives or as monotherapy for women who cannot or prefer not to use hormonal options. For maximum effectiveness, patients should take the medication with food and maintain consistent timing between doses. Some studies suggest that tranexamic acid can reduce menstrual blood loss by approximately 40-60% 1, and it is generally well-tolerated. However, the evidence for its use in abnormal uterine bleeding is largely based on studies of women with menorrhagia, and more research is needed to confirm its effectiveness in other types of abnormal uterine bleeding. In general, tranexamic acid is a safe and effective treatment option for abnormal uterine bleeding, and it can be used in conjunction with other treatments, such as hormonal therapies or surgical interventions, as needed. It is essential to note that while the provided evidence includes various studies and guidelines, the most relevant and recent study for this specific question is 1, which supports the use of tranexamic acid for abnormal uterine bleeding. Other studies, such as 1, 1, and 1, provide additional information on the use of tranexamic acid in different contexts, but they are not directly applicable to this specific question. Therefore, the recommended dose and treatment regimen of tranexamic acid for abnormal uterine bleeding are based on the evidence from 1.
From the Research
Recommended Dose of Tranexamic Acid
The recommended dose of tranexamic acid for abnormal uterine bleeding varies across studies.
- A study published in 2012 2 recommends an oral dosage of 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle.
- Another study from 2009 3 used a dose of 500 mg of tranexamic acid three times a day during menses.
- A 2006 study 4 compared the efficacy and safety of 2 g/day tranexamic acid with medroxyprogesterone acetate in dysfunctional uterine bleeding.
Treatment Regimen
The treatment regimen for abnormal uterine bleeding using tranexamic acid typically involves:
- Starting the medication from the first day of the menstrual cycle 2
- Taking the medication for 4-5 days 2 or during menses 3
- Using the medication in combination with other treatments, such as iron preparations 3 or nonsteroidal anti-inflammatory drugs 5
Efficacy and Safety
Tranexamic acid has been shown to be effective in reducing menstrual blood loss by 26%-60% 2 and improving the quality of life of women treated for heavy menstrual bleeding 2.
- A study from 2009 3 reported a 66.0% response rate to oral tranexamic acid in patients with excessive dysfunctional perimenopausal bleeding.
- Another study from 2006 4 found that 2 g/day tranexamic acid was an effective and safe option in dysfunctional uterine bleeding, with a mean reduction of blood loss of 60.3% after 3 months.
- Tranexamic acid is generally well-tolerated, with few and mainly mild adverse effects 2.