Tranexamic Acid (Heavy Menstrual Bleeding)

How it works

It competitively inhibits the activation of plasminogen to plasmin, reducing clot breakdown in the endometrium and thereby decreasing menstrual blood loss.

Prescribing in practice

• It is contraindicated in active thromboembolic disease and used with caution where there is a personal or strong family history of venous thromboembolism.
• It is taken only on the days of heavy bleeding and is a suitable choice for women who wish to avoid hormonal treatment or who are trying to conceive.
• Gastrointestinal upset is the commonest adverse effect, and it does not provide contraception.

Monitoring

Monitoring is by clinical response; review if bleeding does not improve after a few menstrual cycles to reconsider the diagnosis and treatment.

Counselling the patient

• Take it only during your period on the heavy-bleeding days, as directed.
• It reduces bleeding but does not act as a contraceptive or treat pain.
• Stop and seek advice if you develop calf pain or swelling, breathlessness, or visual disturbance.

Evidence & guidelines

NICE recommends tranexamic acid as a first-line non-hormonal option for heavy menstrual bleeding.