Oral Tranexamic Acid Management for Heavy Menstrual Bleeding
The recommended dosage for oral tranexamic acid (TXA) for heavy menstrual periods is 3.9-4 g/day (divided into 3-4 doses) for 4-5 days starting from the first day of menstruation. 1, 2, 3
Dosing Regimen
- Standard dosing: 1000-1300 mg orally three times daily (3.9-4 g/day total) 1, 2
- Duration: Take for 4-5 days starting from the first day of menstrual flow 2, 3
- Timing: Only during menstruation (not continuous therapy) 4
- Alternative regimen: Some studies have used 1.5 g three times daily for 5 days 3
Efficacy
Tranexamic acid is highly effective for heavy menstrual bleeding:
- Reduces menstrual blood loss by 26-60% compared to baseline 2
- Significantly more effective than NSAIDs, oral progestins, and placebo 3
- In quality-of-life studies, 81% of women were satisfied with treatment, and 94% reported decreased menstrual blood loss 3
- Equally effective as combined oral contraceptives in reducing mean blood loss 5
Patient Selection and Contraindications
TXA is contraindicated in patients with:
- Active thromboembolic disease 2
- History of thrombosis or thromboembolism 2
- Intrinsic risk for thrombosis 2
TXA should be used with caution in patients with:
- Renal insufficiency (requires dose adjustment) 6
Monitoring and Follow-up
- Assess treatment response after 3 months 1
- Monitor for adverse effects, particularly gastrointestinal symptoms 3
- No specific laboratory monitoring required during therapy
Adverse Effects
- Generally well-tolerated with few adverse effects 2, 3
- Most common side effects are gastrointestinal (nausea, vomiting, diarrhea, dyspepsia) 3
- Total incidence of gastrointestinal side effects is approximately 12% (similar to placebo) 3
- No evidence of increased thrombotic events with proper patient selection 2
Alternative and Adjunctive Treatments
If TXA is insufficient or contraindicated, consider:
- NSAIDs (e.g., ibuprofen, mefenamic acid) for 5-7 days during bleeding 1
- Levonorgestrel-releasing intrauterine device (more effective than TXA but has higher rates of amenorrhea) 3
- Combined oral contraceptives (equally effective as TXA) 5
- For patients with fibroids, GnRH agonists/antagonists may be more appropriate 7, 1
Clinical Pearls
- TXA works by preventing fibrin degradation, addressing the excessive fibrinolysis often present in heavy menstrual bleeding 4
- TXA should be taken regardless of symptom improvement throughout the treatment period 1
- TXA is a non-hormonal option, making it suitable for women who cannot or prefer not to use hormonal treatments 4
- For optimal results, start TXA at the onset of menstruation rather than waiting until bleeding becomes heavy 1, 2
TXA represents a first-line, non-hormonal treatment option for heavy menstrual bleeding that is effective, well-tolerated, and only requires administration during menstruation.