Heavy Menstrual Bleeding

Question 1

what is tranexamic acid used for?

Answer 1

reduction of heavy menstrual bleeding over several cycles in women aged 18 years and over with regular 21-35 day cycles, with no more than 3 days individual variability in cycle duration

Question 2

How does transexamic acid work?

Answer 2

it is an anti-fibrinolytic which inhibits fibrinolysis, which increases clot formation and reduces blood loss.

Question 3

what symptoms indicate referral of patients with menorrhagia?

Answer 3

intermenstrual bleeding, postcoital bleeding, pelvic pain, tx failure

Question 4

what are the C/I of tranexamic acid?

Answer 4

1. mild to moderate renal insufficiency
2. hypersensitivity to tranexamic acid or any of the excipients
3. acite thromembolic disease
4. previous thrombolic event and hx of thrombophilia
5. haematuria
6. irregular menstrul bleeding
7. pts on warfarin or other anticoagulants
8. pts taking COC or unopposed oestrogen or tamoxifen
9. Pregnancy

Question 5

when should tranexamic acid be given?

Answer 5

when bleeding starts

Question 6

what is the recommended dosage?

Answer 6

2 tablets TDS for a max of 4 days

but if there is very menstrual bleeding, the dosage may be increased to 4g daily.

Question 7

What does NICE guidelines state about the duration of transxemic acid?

Answer 7

if no improvement in symptoms within 3 menstrual cycles then use of NSAIDS and or transexamic acid should be stopped

Question 8

What are side effects reported with transexamic acid?

Answer 8

mild nausea, vomiting, diarrhoea (affecting 1-10% of pts)

Visual disturbances and thomboembolic events have been reported but are very rare

Question 9

What does tranexamic acid interact with?

Answer 9

fibrinolytic agents, anticoagulants, COC, tamoxifen