From the Guidelines
Tranexamic acid should be dosed at 1,000-1,300 mg orally three times daily for menorrhagia, as this regimen has been shown to significantly reduce menstrual blood loss. When considering treatment options for menorrhagia, it is essential to weigh the benefits and risks of each medication.
- Tranexamic acid works by inhibiting fibrinolysis, which helps stabilize blood clots and reduces heavy menstrual flow 1.
- The medication can cause mild side effects, including nausea, vomiting, or diarrhea, and is contraindicated in women with active thromboembolic disease, history of thrombosis, or intrinsic risk for thrombosis 1.
- According to the available evidence, tranexamic acid can reduce menstrual blood loss by approximately 40-60% and may be used alongside hormonal treatments if needed 1.
- Patients should be advised to take the medication with food to minimize gastrointestinal side effects and to start treatment when bleeding begins, continuing until bleeding lessens, usually for no more than 5 days per menstrual cycle.
- It is crucial to note that the medication should be used with caution in patients with renal impairment, requiring dose adjustment (reduced dose or frequency) if creatinine clearance is below 60 mL/min.
- While other treatment options, such as NSAIDs, have been studied, the evidence for tranexamic acid is more robust, making it a preferred choice for menorrhagia treatment 1.
From the Research
Tranexamic Acid Dosing for Menorrhagia
- The recommended dosage of tranexamic acid for menorrhagia varies, but common dosages include 1-1.5 g three times daily for 5 days 2, 3.
- A study found that tranexamic acid 2-4.5 g/day for 4-7 days reduced menstrual blood loss by 34-59% over 2-3 cycles 2.
- High doses of tranexamic acid, such as 3 grams daily in four divided doses for the first 5 days of the menstrual cycle, have been used to treat severe menorrhagia in patients with von Willebrand disease 4.
- The efficacy of tranexamic acid in reducing menstrual blood loss has been demonstrated in several studies, with reductions in blood loss ranging from 34-59% 2 to 49% 3.
- Tranexamic acid has been shown to be a safe and effective treatment for menorrhagia, with few adverse events reported 2, 3, 5.
Comparison to Other Treatments
- Tranexamic acid has been compared to other treatments for menorrhagia, including mefenamic acid, flurbiprofen, etamsylate, and oral luteal phase norethisterone, and has been found to be more effective in reducing menstrual blood loss 2.
- Levonorgestrel IUD has been found to be more effective than tranexamic acid in reducing menstrual blood loss, but may have a higher incidence of adverse events such as intermenstrual bleeding 2, 6.
- Tranexamic acid has been recommended as a first-line treatment for idiopathic menorrhagia, especially for patients in whom hormonal treatment is contraindicated or not desired 2, 6.
Patient Response and Quality of Life
- Studies have shown that tranexamic acid can improve quality of life in patients with menorrhagia, with reductions in impairment during menstruation and improvements in hematological parameters 3, 5.
- The response rate to tranexamic acid treatment has been reported to be around 65-81% in different studies 3, 5.