From the Guidelines
Tranexamic acid is not contraindicated for patients on birth control, but its use requires caution due to the potential increased risk of thromboembolic complications. According to the most recent guidelines, tranexamic acid has been proven to reduce bleeding in most surgical settings and has been found to be safe in terms of thromboembolic risk 1. However, when combined with hormonal contraceptives, which also increase thrombosis risk, the potential for compounded risk exists. The U.S. selected practice recommendations for contraceptive use suggest that antifibrinolytic agents like tranexamic acid can be used to treat heavy or prolonged bleeding in patients using certain contraceptive methods, such as the implant 1.
Key Considerations
- Patients without additional risk factors for thrombosis can use the combination with appropriate monitoring.
- Patients with a personal or strong family history of blood clots, those who smoke, are over 35 years old, have hypertension, or other cardiovascular risk factors should discuss this combination carefully with their healthcare provider.
- Alternative treatments for heavy menstrual bleeding might be considered in high-risk patients.
- The mechanism behind this interaction involves tranexamic acid's antifibrinolytic properties combined with estrogen's prothrombotic effects, potentially creating conditions favorable for clot formation.
- Patients should report symptoms like leg pain, swelling, chest pain, or shortness of breath immediately if they occur while using this combination.
Monitoring and Treatment
- Patients on birth control who are prescribed tranexamic acid should be closely monitored for signs of thromboembolic complications.
- Treatment options for bleeding irregularities while using contraception, including the use of tranexamic acid, should be individualized based on patient preferences, treatment goals, and medical history 1.
From the FDA Drug Label
Tranexamic acid is contraindicated in patients with active intravascular clotting. ... Avoid concomitant use of Tranexamic acid and medical products that are pro-thrombotic, as the risk of thrombosis may be increased. These medications include but are not limited to, Factor IX Complex concentrates, Anti-inhibitor Coagulant concentrates, and hormonal contraceptives [see Drug Interactions (7.1), Use in Specific Populations (8.3)].
Tranexamic acid is contraindicated for patients on hormonal contraceptives, also known as birth control, due to the increased risk of thrombosis 2.
From the Research
Tranexamic Acid and Birth Control
- There is no direct evidence in the provided studies that suggests tranexamic acid is contraindicated for patients on birth control 3.
- The studies primarily focus on the use of tranexamic acid in the context of postpartum hemorrhage and its effectiveness in reducing bleeding-related mortality 4, 5, 6, 7.
- One study mentions the use of tranexamic acid in patients with various conditions, including those taking combined hormonal contraceptives, but does not specifically address contraindications 3.
- The lack of direct evidence on the interaction between tranexamic acid and birth control means that no definitive conclusion can be drawn about contraindications.
- However, it is essential to consider the potential risks and benefits of using tranexamic acid in patients on birth control, and healthcare providers should consult relevant guidelines and pharmacovigilance surveys to ensure safe and effective treatment 7.