Tranexamic Acid: a Medical Option for Women with Heavy Menstrual Bleeding
By Alicia Armeli

NSAID-Tranexamic-Acid

Imagine periods that make it impossible to sit through your favorite movie because you have to change your tampon—twice. Or bleeding that involves passing clots the size of quarters. Picture this happening every month to the point of becoming anemic. According to one US survey, heavy menstrual bleeding is common—so common that if affects one out of every five women.1

To treat relentless periods, doctors often suggest medical therapy as the first line of defense. One drug in particular called tranexamic acid has shown to reduce heavy menstrual bleeding and improve overall quality of life without major side effects.

“Tranexamic acid, also known as Lysteda, isn’t a hormone but an antifibrinolytic agent,” explains Dr. Linda Bradley, MD, Gynecologic Surgeon, Professor of Surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. “Antifibrinolytics target the endometrium, which are the cells that produce menstruation, and decrease the breakdown of blood, making you bleed less.”

In clinical trials, tranexamic acid reduced heavy bleeding by over 40 percent and provided greater relief in comparison to placebo, NSAID medications, and some hormonal drugs.2,3,4 These benefits were seen to be consistent for a number of conditions, including inherited bleeding disorders, uterine fibroids, and in women where the cause for heavy bleeding is unknown.

“It’s important for women to understand that for the medication to work, it has to be taken as prescribed, which is two pills every eight hours for the first five days of your period—even if your first day isn’t heavy,” Dr. Bradley recommends.

A major benefit is that when taken properly, results are immediate. Unlike other drugs that take months to see improvement, tranexamic acid starts working during the first period. Seeing fast results helps women and doctors decide whether to continue this line of therapy or try something different.

Another advantage is minimal side effects. Reactions to the medication are usually symptoms related to menstruation—like headache, back pain, and fatigue. In rare events, tranexamic acid has been shown to cause uterine fibroid tissue break down, which could cause low-grade fever and pelvic pain in these women.5

Given the nature of the drug and its ability to slow the dissolving of clots, a recent concern with tranexamic acid is the risk for blood clot formation. “Tranexamic acid isn’t recommended for patients with a history of blood clots, heart attack, or stroke,” Bradley tells Ask4UFE. “However, in clinical trials among patients without these risks, there have been zero reports of blood clots when the drug is taken orally.”

Because of its safety and efficacy, tranexamic acid is used to treat more than heavy periods. Studies have shown it to help control bleeding in gynecological, urologic, orthopedic, vascular, and hepatic surgeries, as well as reduce blood loss among trauma patients. 6,7 Intravenously, its effectiveness in treating postpartum bleeding is currently being studied.7

Although just approved by the FDA in 2009 to treat heavy menstrual bleeding, for years tranexamic acid has been available over the counter in countries like Canada and Britain. “Tranexamic acid is an effective non-invasive treatment option and can provide relief to women with heavy bleeding who also want to spare their fertility,” says Dr. Bradley. “Now that it can be prescribed in the US, I think patients and doctors should be aware of its benefits.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR  Linda Bradley, MD is an internationally recognized gynecologic surgeon, professor of surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program and recipient of the American College of Obstetricians and Gynecologists Pete and Weesie Hollis Community Service Award, Dr. Bradley is dedicated to empowering multicultural women to take charge of their health, embracing self-care, and creating positive change in the world.

REFERENCES

  1. Centers for Disease Control and Prevention. (2015). Heavy Menstrual Bleeding. Retrieved July 11, 2016, from https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
  2. Bradley, L. D., & Gueye, N. A. (2016). The medical management of abnormal uterine bleeding in reproductive-aged women. American Journal of Obstetrics and Gynecology, 214(1): 31-44. doi: 10.1016/j.ajog.2015.07.044
  3. Lukes, A. S., Moore, K. A., Muse, K. N., Gersten, J. K., Hecht, B. R. Edlund, M., Richter, H. E., Eder, S. E., Attia, G. R., Patrick, D. L., Rubin, A., & Shangold, G. A. (2010). Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstetrics & Gynecology, 116(4): 865-875. doi: 10.1097/AOG.0b013e3181f20177
  4. Leminen, H., & Hurskainen, R. (2012). Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. International Journal of Women’s Health, 4: 413-421. doi: 10.2147/IJWH.S13840
  5. Ip, P. P., Lam, K. W., Cheung, C. L., Yeung, M. C., Pun, T. C., Chan, Q. K., & Cheung, A. N. (2007). Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas. The American Journal of Surgical Pathology, 31(8): 1215-1224.
  6. Peitsidis, P., & Koukoulomati, A. (2014). Tranexamic acid for the management of uterine fibroid tumors: A systematic review of the current evidence. World Journal of Clinical Cases, 2(12): 893-898. doi: 10.12998/wjcc.v2.i12.893
  7. Bonnett, M. P., & Benhanou, D. (2016). Management of postpartum haemorrhage. F1000 Research. doi:  10.12688/f1000research.7836.1