What is the recommended dose of tranexamic acid (TXA) for heavy menstrual bleeding?

Recommended Dosage of Tranexamic Acid for Heavy Menstrual Bleeding

The recommended oral dosage of tranexamic acid for heavy menstrual bleeding is 3.9-4 g per day divided into 3-4 doses, taken for 4-5 days starting from the first day of the menstrual cycle. 1

Dosage Guidelines

• Oral tranexamic acid should be administered at a dose of 3.9-4 g daily, divided into 3-4 doses (approximately 1000-1300 mg per dose) 1, 2
• Treatment should begin on the first day of menstrual bleeding 1
• The medication should be continued for 4-5 days during menstruation 1, 2
• This dosing regimen has been shown to reduce menstrual blood loss by 26%-60% compared to baseline 1
• A lower dose of 1.95 g/day may provide some benefit but does not meet all efficacy endpoints in clinical trials 3

Evidence of Efficacy

• Tranexamic acid significantly reduces menstrual blood loss compared to placebo, NSAIDs, oral progestins, and etamsylate 2
• In clinical studies, tranexamic acid reduced menstrual blood loss by 34-59% over 2-3 cycles 2
• The 3.9 g/day dose has been shown to provide clinically meaningful reduction in menstrual blood loss in controlled trials 3
• Tranexamic acid significantly improves quality of life in women with heavy menstrual bleeding 1
• In a large quality-of-life study, 81% of women were satisfied with tranexamic acid treatment, and 94% reported decreased menstrual blood loss 2

Alternative Options and Comparisons

• Levonorgestrel-releasing intrauterine systems provide greater reduction in menstrual blood loss (up to 96%) compared to tranexamic acid, but may cause amenorrhea in up to 44% of patients 2
• Tranexamic acid and combined oral contraceptives appear equally effective in reducing mean blood loss in patients with heavy menstrual bleeding 4
• For patients with uterine fibroids (leiomyomas), combined oral contraceptives may be more effective than tranexamic acid 4

Safety Considerations

• The most common adverse events are gastrointestinal in nature (nausea, vomiting, diarrhea, dyspepsia) 2
• Tranexamic acid should be used with caution in patients taking oral contraceptives due to increased thrombotic risk 5
• Active thromboembolic disease is an absolute contraindication 1
• In the US, a history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis are considered contraindications 1
• Dose adjustment is required in patients with renal dysfunction 5
• Tranexamic acid should be discontinued 5 days before high bleeding risk procedures 5

Clinical Considerations

• Tranexamic acid is particularly useful for women who desire immediate pregnancy or for whom hormonal treatment is inappropriate 6
• It is considered a cost-effective first-line treatment option for idiopathic heavy menstrual bleeding 2, 6
• The FDA has approved tranexamic acid for treatment of heavy menstrual bleeding, confirming its safety and efficacy profile 1
• Tranexamic acid does not affect the duration of menses in most studies 2

Heavy menstrual bleeding significantly impacts women's quality of life, and tranexamic acid offers an effective non-hormonal treatment option with a well-established safety profile when used according to recommended guidelines.