From the Guidelines
The recommended dose of tranexamic acid (TXA) for menorrhagia is 1,000-1,300 mg taken orally three times daily for up to 5 days during menstruation. This dosage is based on the most recent and highest quality studies available, which have demonstrated the efficacy and safety of TXA in reducing menstrual blood loss in women with menorrhagia 1.
Key Points to Consider
- Treatment should begin when menstrual bleeding starts and continue only for the duration of bleeding, typically 3-5 days per cycle.
- For some patients, a lower dose of 650 mg three times daily may be effective.
- TXA works by inhibiting plasminogen activation, which reduces fibrinolysis and helps stabilize blood clots, thereby decreasing menstrual blood loss.
- This medication is most effective when taken at the first sign of menstrual bleeding rather than waiting until bleeding becomes heavy.
- Common side effects include nausea, diarrhea, and headache.
- TXA should be used with caution in patients with a history of thromboembolism, and is contraindicated in women with active thromboembolic disease, history of thrombosis, or intrinsic risk factors for thrombosis.
- If menorrhagia persists despite treatment, further evaluation for underlying causes is warranted.
Evidence Summary
The evidence supporting the use of TXA for menorrhagia is based on several studies, including a study published in the Journal of Allergy and Clinical Immunology in 2013, which reported that TXA is effective in reducing menstrual blood loss in women with menorrhagia 1. Another study published in the Critical Care journal in 2013 also supported the use of TXA in bleeding trauma patients, demonstrating its safety and efficacy in reducing the risk of death due to bleeding 1.
Clinical Considerations
In clinical practice, it is essential to consider the individual patient's medical history, including any history of thromboembolism or other risk factors for thrombosis, before prescribing TXA for menorrhagia. Additionally, patients should be educated on the proper use of TXA, including the importance of taking the medication at the first sign of menstrual bleeding and continuing it only for the duration of bleeding.
From the Research
Dose of Tranexamic Acid for Menorrhagia
The dose of tranexamic acid (TXA) for menorrhagia varies according to different studies. Here are some key findings:
- A study from 2003 2 found that tranexamic acid 2-4.5 g/day for 4-7 days reduced menstrual blood loss by 34-59% over 2-3 cycles.
- Another study from 2012 3 recommended an oral dosage of 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle.
- A study from 2002 4 used a high dose of tranexamic acid, 3 grams daily in four divided doses for the first 5 days of the menstrual cycle, to treat severe menorrhagia in patients with von Willebrand disease.
- Other studies 5, 6 used doses of 1.5 gm three times a day for 3 days and 1 gm twice a day for another 2 days, and 1 g four times a day for the first four days of menstruation, respectively.
Key Findings
Some key findings from the studies include:
- Tranexamic acid is an effective treatment for heavy menstrual bleeding, reducing menstrual blood loss by 26%-60% 3.
- The treatment is generally well-tolerated, with few and mainly mild adverse effects 2, 3.
- The recommended dose and duration of treatment may vary depending on the individual patient and the severity of their menorrhagia.
Dosage Summary
In summary, the dose of tranexamic acid for menorrhagia can range from 1-4 grams per day, taken for 3-7 days during the menstrual cycle, as seen in studies 2, 3, 4, 5, 6.