What is the prescription for Tranexamic Acid (TXA) for menorrhagia?

From the Guidelines

Tranexamic acid (TXA) should be prescribed at a dose of 1,000-1,300 mg orally three times daily for the treatment of menorrhagia, taken only during menstruation, starting when bleeding begins and continuing for up to 5 days or until bleeding stops. This recommendation is based on the most recent evidence available, which suggests that TXA is a nonhormonal alternative agent that may reduce bleeding symptoms in patients with fibroids 1, 2. The medication works by inhibiting fibrinolysis, thereby reducing menstrual blood loss by approximately 40-60%.

Key Considerations for Prescription

• The standard regimen is 1,000 mg three times daily for the first 3-4 days of menstruation when bleeding is typically heaviest.
• TXA should be taken with food to minimize gastrointestinal side effects.
• Patients should be advised that common side effects may include nausea, vomiting, diarrhea, and headache.
• TXA is contraindicated in women with active thromboembolic disease, history of thrombosis, or known thrombophilia.
• It can be used alongside hormonal treatments like birth control pills if needed.

Monitoring and Safety

• Patients should contact their healthcare provider if they experience severe headaches, vision changes, or symptoms of blood clots such as calf pain, chest pain, or shortness of breath while taking this medication.
• The use of TXA in patients with a history of thrombosis or thrombophilia requires careful consideration of the benefits and risks, as it may increase the risk of thromboembolic events 1.

Alternative Treatments

• Other medical management options for menorrhagia include NSAIDs, estrogen-progestin oral contraceptive pills, and progestin-containing intrauterine devices (IUDs) 2.
• Second-line medical management includes parenteral GnRH agonists and oral GnRH antagonists, which can reduce bleeding symptoms and tumor volume, but may have hypoestrogenic effects and require careful consideration of the benefits and risks 1, 2.

From the Research

Prescription for Tranexamic Acid (TXA) for Menorrhagia

The prescription for Tranexamic Acid (TXA) for menorrhagia varies depending on the study. Here are some key points:

• A study published in 2003 3 found that tranexamic acid 2-4.5 g/day for 4-7 days reduced menstrual blood loss by 34-59% over 2-3 cycles.
• Another study published in 2002 4 used a high dose of tranexamic acid, 3 grams daily in four divided doses for the first 5 days of the menstrual cycle, to treat severe menorrhagia in patients with von Willebrand disease.
• A study published in 2006 5 used 2 g/day of tranexamic acid to manage dysfunctional uterine bleeding, with a mean reduction of blood loss of 60.3% after 3 months.
• The current dosage of tranexamic acid used in menorrhagia is 4 g/day, as mentioned in a study published in 2006 5.

Dosage and Administration

Some key points about the dosage and administration of tranexamic acid for menorrhagia are:

• Tranexamic acid can be administered orally, with dosages ranging from 1.5 g to 4 g per day, divided into 2-4 doses 3, 5.
• The duration of treatment varies, but it is typically given for 3-5 days during the menstrual cycle 3, 4.
• High doses of tranexamic acid, up to 3 grams daily, may be necessary for severe menorrhagia in patients with von Willebrand disease 4.

Efficacy and Safety

The efficacy and safety of tranexamic acid for menorrhagia have been evaluated in several studies, including:

• A systematic review published in 2012 6 found that tranexamic acid therapy resulted in a 34-54% reduction in menstrual blood loss and improved patient quality of life.
• A study published in 2003 3 found that tranexamic acid was well-tolerated, with the most common adverse events being gastrointestinal in nature.
• Another study published in 2006 5 found that 2 g/day of tranexamic acid was an effective and safe option for managing dysfunctional uterine bleeding.