What is the recommended dosage of Lysteda (tranexamic acid) for treating heavy menstrual bleeding?

Tranexamic Acid (Lysteda) Dosing for Heavy Menstrual Bleeding

The recommended dosage of Lysteda (tranexamic acid) for treating heavy menstrual bleeding is 1,300 mg (two 650 mg tablets) taken three times daily (3,900 mg/day total) for up to 5 days during monthly menstruation, starting from the first day when heavy bleeding begins.

Mechanism of Action and Efficacy

Tranexamic acid works by inhibiting plasminogen activation, which reduces fibrinolysis and consequently decreases menstrual blood loss. Clinical studies have demonstrated that:

• Tranexamic acid reduces menstrual blood loss by 34-59% compared to baseline 1, 2
• The 3,900 mg/day dose (1,300 mg three times daily) has been shown to be the most effective dosing regimen 3
• It is significantly more effective than placebo, NSAIDs, oral progestins, and etamsylate 2

Dosing Algorithm

1. Starting dose: 1,300 mg (two 650 mg tablets) three times daily
2. Duration: Maximum of 5 days during menstruation
3. Timing: Begin at the first sign of menstrual bleeding
4. Maximum daily dose: 3,900 mg (six 650 mg tablets)

Contraindications

Tranexamic acid is contraindicated in women with:

• Active thromboembolic disease
• History of thrombosis or thromboembolism
• Intrinsic risk for thrombosis or thromboembolism 4

Adverse Effects

Tranexamic acid is generally well-tolerated. Common side effects include:

• Gastrointestinal symptoms (nausea, vomiting, diarrhea, dyspepsia) - occurring in approximately 12% of patients 2
• Headache
• Fatigue

Clinical Considerations

• Tranexamic acid should be considered as a first-line treatment for idiopathic heavy menstrual bleeding, especially for patients who cannot or do not wish to use hormonal treatments 2
• It can significantly improve quality of life parameters by 46-83% in women with heavy menstrual bleeding 5
• The medication is particularly valuable for women who desire immediate pregnancy or for whom hormonal treatment is inappropriate 6
• For women with copper IUD-associated heavy bleeding, tranexamic acid has been shown to reduce blood loss by approximately 70% compared to placebo 5

Monitoring

• No specific laboratory monitoring is required during treatment
• Assess treatment response after 2-3 menstrual cycles
• Consider alternative treatments if bleeding persists and remains unacceptable to the patient 4

Alternative Treatments

If tranexamic acid is ineffective or contraindicated, consider:

• NSAIDs (for short-term treatment)
• Hormonal options (if not contraindicated)
• Levonorgestrel-releasing intrauterine system (provides greater reduction in menstrual blood loss but has higher rates of amenorrhea) 1
• Surgical interventions for refractory cases

Tranexamic acid offers a non-hormonal, effective approach to managing heavy menstrual bleeding with minimal side effects and significant improvements in quality of life.