Antifibrinolytics (such as tranexamic acid) for treatment of | Figure 1

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Antifibrinolytics (such as tranexamic acid) for treatment of heavy menstrual bleeding

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Cochrane Review; 12 trials (312 women with heavy menstrual bleeding (HMB: defined as more than 80 millilitres (> 80 mL) of blood loss per menstrual cycle), comparing an antifibrinolytic medication with placebo or a different medical therapy.

Key results

Antifibrinolytic medication may improve HMB in women aged 15 to 50 years old, without substantially increasing the rate of adverse events. Evidence suggests there is a 40%-50% reduction in the amount of menstrual blood lost per menstrual cycle for participants taking tranexamic acid (TXA). Antifibrinolytic treatment was better at improving HMB loss than other medical treatments, except for the levonorgestrel intrauterine system (LIUS), a plastic device placed in the uterus which releases hormone to prevent conception.

The evidence suggests that if 10.9% of women taking placebo report an improvement in HMB, 36.3% of women taking TXA will do so.

TXA probably improves quality of life for women with HMB.

No evidence was found to suggest that side effects (including life-threatening blood clots) were increased in women taking antifibrinolytic treatment compared to placebo or other treatments for HMB. Two studies measured venous thromboembolic events: unfortunately these studies did not have enough participants to draw any conclusions.

The evidence was of very low to moderate quality.

Read the full Cochrane Review here

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