What medication can stop intense vaginal bleeding?

Medications for Intense Vaginal Bleeding

For intense vaginal bleeding, tranexamic acid is strongly recommended as the most effective medication, with NSAIDs as an alternative for less severe cases. 1, 2

First-Line Treatment: Tranexamic Acid

• Tranexamic acid is highly effective for controlling intense vaginal bleeding, reducing blood loss by 26-60% compared to placebo 2
• For postpartum hemorrhage: Administer 1g IV tranexamic acid within 3 hours of birth, with a second 1g dose if bleeding continues after 30 minutes or restarts within 24 hours 1
• For heavy menstrual bleeding: Recommended oral dosage is 3.9-4g/day divided into doses for 4-5 days starting from the first day of menstruation 2, 3
• Tranexamic acid works by blocking lysine binding sites on plasminogen, preventing fibrin degradation and thus reducing bleeding 3

Alternative Treatment: NSAIDs

• For less severe bleeding or when tranexamic acid is contraindicated, NSAIDs can be used for short-term treatment (5-7 days) 1
• Multiple NSAIDs have shown efficacy in reducing menstrual blood loss, including:
  • Mefenamic acid 1, 3
  • Indomethacin 1
  • Flufenamic acid 1
  • Diclofenac sodium 1, 3
• NSAIDs are less effective than tranexamic acid but have fewer contraindications 3

Treatment Algorithm

1. Assess severity and cause of bleeding:

   • If postpartum hemorrhage: Use tranexamic acid IV immediately (within 3 hours) 1
   • If heavy menstrual bleeding: Consider underlying causes (IUD displacement, STDs, pregnancy, fibroids, polyps) before treatment 1, 4

2. For intense bleeding without contraindications:

   • First choice: Tranexamic acid 1, 2
   • If contraindicated: NSAIDs 1

3. For moderate bleeding:

   • NSAIDs for 5-7 days during days of bleeding 1
   • If ineffective, consider tranexamic acid 2

4. For bleeding associated with hormonal contraception:

   • For Cu-IUD related bleeding: NSAIDs for 5-7 days 1
   • For hormonal contraceptive users: Consider combined oral contraceptives with 30-35μg ethinyl estradiol 5

Contraindications and Precautions

• Tranexamic acid is contraindicated in:

  • Active thromboembolic disease 1
  • History of thrombosis or thromboembolism 2
  • Intrinsic risk for thrombosis 1, 2

• Despite theoretical concerns, evidence does not show increased incidence of thrombotic events with tranexamic acid use for menstrual bleeding 2, 6

• NSAIDs may cause gastrointestinal side effects and are contraindicated in patients with certain gastrointestinal conditions 1

Monitoring and Follow-up

• Assess treatment effectiveness after one cycle of therapy 1
• If bleeding persists despite treatment, further investigation for underlying gynecological conditions is warranted 1, 4
• For postpartum hemorrhage, continue monitoring vital signs and bleeding after tranexamic acid administration 1

Special Considerations

• Tranexamic acid has been shown to improve quality of life in women with heavy menstrual bleeding 2, 6
• Early administration of tranexamic acid (within 3 hours) for postpartum hemorrhage is critical - effectiveness decreases by 10% for every 15-minute delay 1
• For elective cesarean sections, prophylactic tranexamic acid has been shown to decrease blood loss by approximately 25% 7