What is the recommended treatment and dosage for heavy menstrual bleeding using Lysteda (tranexamic acid)?

Lysteda (Tranexamic Acid) for Heavy Menstrual Bleeding

For heavy menstrual bleeding, Lysteda (tranexamic acid) should be dosed at 1,300 mg (two 650 mg tablets) three times daily for a maximum of 5 days during menstruation, totaling 3.9 g/day. 1

Recommended Dosing Regimen

• Standard dose: 3.9 g/day (1,300 mg three times daily) taken only during days of active menstrual bleeding 1
• Maximum treatment duration: 5 days per menstrual cycle 1, 2
• Timing: Initiate at the beginning of heavy menstrual bleeding 2
• The 3.9 g/day dose met all three primary efficacy endpoints in clinical trials, while the lower 1.95 g/day dose was less effective 1

Expected Efficacy

• Reduces menstrual blood loss by 26-60% compared to baseline 3
• Approximately 80 mL reduction in menstrual blood loss per cycle 4
• Significantly more effective than placebo, NSAIDs, oral cyclical luteal phase progestins, and oral etamsylate 3
• Provides meaningful improvement in quality of life for women with heavy menstrual bleeding 3, 5

Position in Treatment Algorithm

Tranexamic acid is a second-line treatment option after NSAIDs for women not using the levonorgestrel-releasing intrauterine device (LNG-IUD). 6, 4

First-line options:

• LNG-IUD: Most effective treatment (71-95% reduction in menstrual blood loss) 6, 4
• NSAIDs: First-line pharmacologic treatment for 5-7 days during menstruation 6, 4

When to use tranexamic acid:

• NSAIDs are ineffective or contraindicated 6
• Patient desires non-hormonal treatment 5
• Patient desires immediate pregnancy 5
• Hormonal treatments are inappropriate 5

Critical Contraindications

Absolute contraindications (these are non-negotiable):

• Active thromboembolic disease 3, 2
• History of thrombosis or thromboembolism 3, 2
• Intrinsic risk for thrombosis or thromboembolism 3, 2
• Cardiovascular disease (increased risk of thrombosis and MI) 6, 4

Common Pitfall:

Do not use tranexamic acid in women with cardiovascular risk factors or established cardiovascular disease, as this significantly increases thrombotic risk. 6, 4 Screen all patients for cardiovascular disease and thrombotic history before prescribing. 4

Renal Dosing Adjustments

• Dosage adjustments are required for women with renal insufficiency 2
• Evaluate renal function before initiating therapy 2

Safety Profile

• Adverse effects are generally mild to moderate 2
• Most common side effects: menstrual discomfort, headache, back pain 2
• No evidence of increased thrombotic events in women without contraindications 3
• No serious study-related adverse events in clinical trials 1
• Well-tolerated and cost-effective 5

Essential Pre-Treatment Assessment

Before prescribing tranexamic acid:

• Rule out pregnancy in all reproductive-age women 6, 4
• Exclude structural causes (fibroids, polyps, adenomyosis, endometrial pathology, malignancy) 6, 4
• Screen for coagulopathies if clinically indicated 6
• Review current medications, particularly anticoagulants or antiplatelet therapy 6
• Assess cardiovascular and thrombotic risk factors 4

Patient Counseling

• Provide enhanced counseling about expected bleeding patterns 4
• Reassure patients that treatment effects may improve over time 4
• Emphasize that medication should only be taken during days of active bleeding, not throughout the entire cycle 2
• Discuss that tranexamic acid improves quality of life in women with heavy menstrual bleeding 3, 5