What is the recommended dosage of tranexamic acid (TXA) for a healthy female patient of reproductive age with heavy menses and no history of thromboembolic events?

Tranexamic Acid Dosing for Heavy Menstrual Bleeding

For a healthy reproductive-age woman with heavy menses and no thromboembolic history, administer tranexamic acid 1,300 mg orally three times daily (total 3.9 g/day) for up to 5 days starting on the first day of menstruation. 1, 2

Standard Dosing Regimen

• The recommended dose is 1,300 mg orally three times daily for 4-5 days per menstrual cycle, totaling 3.9 g/day 1, 3
• Treatment should begin on the first day of menstrual bleeding and continue for up to 5 days (maximum 15 doses per cycle) 4, 2
• This dosing reduces menstrual blood loss by 34-60% compared to baseline 1, 3

Clinical Efficacy

• Tranexamic acid reduces mean menstrual blood loss by approximately 69.6 mL (40.4% reduction) compared to placebo reduction of only 12.6 mL 2
• The medication is significantly more effective than NSAIDs, oral progestins, or etamsylate for reducing menstrual blood loss 1
• Improvements in hemoglobin and ferritin levels occur with long-term use, with mean hemoglobin increasing by ≥0.71 g/dL after 3 cycles in women with baseline anemia 5
• Among women with low hemoglobin (<12 g/dL) at baseline, 34.1% normalize after 3 cycles and 45.7% after 27 cycles 5

Quality of Life Benefits

• Significant improvements in health-related quality of life occur during the first treatment cycle and are maintained throughout long-term use 4, 2
• Women experience measurable improvements in social activities, physical activities, work performance, and self-perceived menstrual blood loss 2

Safety Profile

• Adverse effects are predominantly mild to moderate, with headache, menstrual discomfort, and back pain being most common 4
• Gastrointestinal side effects occur at rates comparable to placebo with the modified-release formulation 2
• No evidence exists of increased thrombotic events in women without pre-existing thromboembolic disease 1

Critical Contraindications

• Active thromboembolic disease is an absolute contraindication 1
• In the United States, FDA labeling includes history of thrombosis/thromboembolism or intrinsic risk for thrombosis as contraindications 6, 1
• Your patient with no thromboembolic history meets safety criteria for tranexamic acid use 1

Common Pitfalls to Avoid

• Do not prescribe tranexamic acid for continuous daily use—it should only be taken during menstruation for 4-5 days per cycle 1, 4
• Do not reduce the dose below 3.9 g/day, as lower doses have not been adequately studied for efficacy 1, 2
• Do not use tranexamic acid as first-line therapy in women with known thrombophilia or active clotting disorders 6
• Ensure patients understand to start medication on day 1 of bleeding, not prophylactically before menses 1

Long-Term Use Considerations

• Long-term treatment (up to 27 cycles) demonstrates sustained efficacy and safety 5, 4
• Monitor hemoglobin levels if baseline anemia is present; consider oral iron supplementation if hemoglobin drops below 11 g/dL 5
• Ferritin levels improve progressively, with 58% of women with low baseline ferritin normalizing after 27 cycles 5