Lysteda Dosing for Heavy Menstrual Bleeding
For heavy menstrual bleeding, take Lysteda (tranexamic acid) 1300 mg (two 650 mg tablets) three times daily for a maximum of 5 days during menstruation, which equals a total daily dose of 3.9 grams. 1, 2
Dosing Frequency and Duration
- Take 1300 mg (two 650 mg tablets) three times daily during menstruation 1, 2
- Maximum duration: 5 days per menstrual cycle 2, 3
- Start on the first day of menstrual bleeding 2
- Stop after 5 days even if bleeding continues 3
Evidence Supporting This Dose
The 3.9 g/day dose is the only FDA-approved regimen that met all three primary efficacy endpoints in clinical trials, including mean menstrual blood loss reduction, patient-reported meaningful reductions, and absolute reductions >50 mL/cycle 1. A lower dose of 1.95 g/day (650 mg three times daily) was studied but only met 2 of 3 efficacy endpoints and is therefore not recommended 1.
Expected Efficacy
- Reduces menstrual blood loss by 26-60% compared to baseline 2, 4
- Significantly improves quality of life in women with heavy menstrual bleeding 2, 4
- More effective than NSAIDs, progestins, or placebo for reducing blood loss 2
Critical Safety Considerations and Contraindications
Absolute contraindications 2, 3:
- Active thromboembolic disease (current blood clots)
- History of thrombosis or thromboembolism
- Intrinsic risk factors for thrombosis or thromboembolism
- Women with cardiovascular disease should avoid tranexamic acid due to increased risk of thrombosis and myocardial infarction 5
- Do not use in pregnancy or lactation 7
- Requires dose adjustment in renal insufficiency 3
Common Side Effects
The most frequently reported adverse effects are mild to moderate 3:
- Menstrual discomfort
- Headache
- Back pain
No serious study-related adverse events occurred in clinical trials, and adverse events did not differ significantly from placebo 1.
When to Consider Alternative Therapy
If bleeding remains unacceptable after 1-3 treatment cycles, consider 6:
- Levonorgestrel-releasing IUD (LNG-IUD): Reduces menstrual blood loss by 71-95% and is more effective than tranexamic acid for long-term management 5, 6
- Combined hormonal contraceptives: Effective for heavy menstrual bleeding if contraception is also desired 6, 8
- NSAIDs: Can be used as first-line therapy (5-7 days during bleeding) before escalating to tranexamic acid 5, 6