From the Guidelines
Tranexamic acid (TXA) is a recommended treatment for managing heavy menstrual bleeding, particularly for women with menorrhagia, as it can reduce menstrual blood loss by up to 40-60%. The typical dosage is 1,000-1,300 mg taken orally three times daily for the first 3-5 days of the menstrual cycle when bleeding is heaviest 1. TXA works by inhibiting the breakdown of blood clots, which helps reduce blood loss during menstruation. This medication is particularly helpful for women who cannot or prefer not to use hormonal options, as it provides a non-hormonal alternative that specifically targets the mechanism of excessive bleeding without affecting the menstrual cycle timing or fertility.
Key Points to Consider
- TXA can be used alongside hormonal treatments like birth control pills or as a standalone treatment for women with heavy menstrual bleeding 1.
- Side effects of TXA are generally mild and may include nausea, vomiting, or diarrhea 1.
- TXA should be used with caution in women with a history of blood clots, and it's essential to consult with a healthcare provider before starting this medication 1.
- The use of TXA may cause necrosis in fibroids and help reduce the menorrhagia associated with fibroids; however, adverse effects such as pelvic pain and fever may result 1.
Clinical Decision Making
When deciding to use TXA for managing heavy menstrual bleeding, it's crucial to consider the individual patient's medical history, preferences, and potential risks. As the most recent and highest quality studies suggest, TXA is a viable option for reducing menstrual blood loss and improving quality of life for women with menorrhagia 1. However, it's essential to weigh the benefits and potential risks of TXA against other treatment options, such as hormonal therapies or surgical interventions, to determine the best course of treatment for each patient.
From the Research
Use of Tranexamic Acid for Menstrual Cycles
The use of tranexamic acid (TXA) for menstrual cycles is primarily for the treatment of heavy menstrual bleeding (HMB) or menorrhagia. Key points about its use include:
- TXA has been proven to be an effective treatment for HMB, reducing menstrual blood loss by 26%-60% 2.
- It is significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate in reducing menstrual blood loss 2, 3.
- The recommended oral dosage is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 2.
- TXA improves the quality of life of women treated for HMB, with 81% of women satisfied with TXA treatment and 94% judging their menstrual blood loss to be 'decreased' or 'strongly decreased' 3.
- Adverse effects are few and mainly mild, with the most commonly reported being gastrointestinal in nature, such as nausea, vomiting, diarrhea, and dyspepsia 3, 4.
Efficacy and Safety
Studies have shown that TXA is effective and safe for the treatment of idiopathic and non-functional HMB:
- A systematic review found that TXA therapy resulted in a 34-54% reduction in menstrual blood loss and improved patient quality of life by 46-83% 4.
- TXA use significantly decreased blood loss by 70% in women with menorrhagia secondary to an intrauterine device compared to placebo 4.
- No thromboembolic events were reported in all studies analyzed, indicating that TXA is safe for use in women with HMB 4, 5, 6.
Benefits and Considerations
The benefits of using TXA for menstrual cycles include:
- Effective reduction of menstrual blood loss
- Improvement in quality of life
- Safe and well-tolerated
- Nonhormonal therapy option
- Can be used in women who desire immediate pregnancy or for whom hormonal treatment is inappropriate 6. However, it is essential to consider the contraindications, such as active thromboembolic disease, and potential adverse effects when prescribing TXA for HMB treatment 2, 3.