What is the recommended dosage of Tranexamic Acid (TXA) for heavy menstrual bleeding?

Tranexamic Acid Dosage for Heavy Menstrual Bleeding

For heavy menstrual bleeding, the recommended dosage of tranexamic acid is 3.9-4 g/day (divided into 3-4 doses) for 4-5 days starting from the first day of the menstrual cycle. 1

Specific Dosing Recommendations

Standard Dosing

• Oral dosage: 3.9-4 g/day divided into 3-4 doses 1
• Duration: 4-5 days starting from the first day of menstruation 1
• Specific regimen example: 1 g four times daily for 4-5 days 1, 2

Modified-Release Formulation

• If using the modified-release formulation, follow the same principle of initiating at the beginning of heavy menstrual bleeding for up to 5 days per cycle 3

Efficacy

• Tranexamic acid reduces menstrual blood loss by 26-60% 1

• It is significantly more effective than:

  • Placebo
  • NSAIDs (including mefenamic acid, flurbiprofen)
  • Oral cyclical luteal phase progestins
  • Etamsylate 1, 2

• In clinical studies, 94% of women judged their menstrual blood loss to be "decreased" or "strongly decreased" after tranexamic acid treatment 2

Special Considerations

Renal Impairment

• Dose adjustments are required for patients with renal impairment 4, 3
• Renal function should be assessed prior to initiating therapy

Severe Cases

• For severe menorrhagia that doesn't respond to standard dosing, higher doses have been used in specific cases
• In patients with von Willebrand disease with severe menorrhagia, doses of 3 g daily in four divided doses have been used successfully when lower doses were ineffective 5

Safety Profile

• Adverse effects are generally few and mild 1
• Most common side effects are gastrointestinal (nausea, vomiting, diarrhea, dyspepsia) 2
• No evidence exists of an increase in the incidence of thrombotic events with standard dosing 1

Contraindications

• Active thromboembolic disease 1
• In the US, a history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis are also considered contraindications 1

Treatment Algorithm

1. Confirm diagnosis of heavy menstrual bleeding (menstrual blood loss >80 mL)
2. Rule out contraindications (active or history of thromboembolic disease)
3. Initiate treatment with tranexamic acid 3.9-4 g/day in 3-4 divided doses
4. Start on day 1 of menstruation
5. Continue for 4-5 days
6. Reassess after 2-3 cycles for efficacy and tolerability

Tranexamic acid should be considered as a first-line treatment for the initial management of idiopathic menorrhagia, especially for patients in whom hormonal treatment is either not recommended or not wanted 2.