Tranexamic acid and heavy periods

What is tranexamic acid?

Tranexamic acid is a medication that has been used since the late 1960s¹. Yet some people have still never heard of it!

Tranexamic acid is a medication which helps to slow down, lighten and stop bleeding. When you have a cut or injury, the cells in your body start to form clots to stop bleeding by sealing any breaks in a blood vessel. However these clots often then break down or dissolve. Tranexamic acid stops the clots from breaking down as quickly, which helps your body to reduce and stop heavy bleeding².

Tranexamic acid is non-hormonal, not addictive and can be taken only when you need it. It does not need to be taken every day.

What forms can it be prescribed in?

Tranexamic acid can be given as a tablet, or as an injection of liquid into the vein.

The tablet dose is usually two tablets, three times a day³. The injection dose is worked out using your weight and can be adjusted by doctors depending on the amount of bleeding.

What is tranexamic used for?

Tranexamic acid has a wide range of uses thanks to years of clinical research. Tranexamic acid uses include³:

• Following surgery to prevent bleeding
• Nose bleeds
• Heavy periods
• Bleeding after delivery (postpartum haemorrhage)
• Following major trauma and some head injuries⁴
• In people who have bleeding conditions that are genetic and run in their families (hereditary conditions)

Tranexamic acid and heavy periods

Heavy periods can have a huge impact on your quality of life. Not only can heavy periods cause embarrassment from leaking and stop you going out, but heavy periods can also cause iron deficiency and anaemia. 

Iron deficiency happens when your body uses up its iron stores to make new red blood cells, but not enough iron is replaced (usually through your diet) to keep up with production. If you cannot make enough red blood cells to replace what you lose, this is called anaemia. Anaemia can make you feel tired, breathless and cause symptoms such as palpitations and chest pain.

Taking tranexamic acid for periods can prevent these symptoms. We have research studies from as far back as 1970 which shows that tranexamic acid is an effective treatment for heavy periods⁵. In fact, 94% of women in one study reported that tranexamic acid for heavy menstrual bleeding decreased or strongly decreased their blood loss compared to their periods without any medical treatment⁶. Other studies have shown that in women who use tranexamic acid for heavy periods, their menstrual blood loss can reduce by between 26% to 60% compared to not taking tranexamic acid⁷.

As tranexamic acid is non-hormonal, it is an option for women who have heavy periods but do not want to or cannot take hormonal contraceptives, or who are trying to get pregnant.

How does tranexamic work to help with heavy periods?

During a heavy period, the lining of the womb is shed and comes out through the cervix and vagina. As the womb lining sheds, blood vessels break causing bleeding. Your body tries to form clots to repair blood vessels and reduce the amount of bleeding. Tranexamic acid prevents the breakdown of these small clots, which reduces menstrual blood loss.

How to take tranexamic acid for heavy periods

You should start tranexamic acid on the first day that your period has started. The dose is two tablets (500mg dose tablets) three times a day. Tranexamic acid should be used for a maximum of four days in a row in each menstrual cycle. If you are taking tranexamic acid and still bleeding, the dose may be increased to four times a day³.

How long does tranexamic acid take to work?

Tranexamic acid may take up to 24 hours to work when taken as tablets⁸. This can vary from person to person.

Can tranexamic acid stop periods?

Tranexamic acid is non-hormonal so has no impact on your menstrual cycle. As tranexamic acid is only used when your period has started, it cannot prevent or stop your period. 

Research studies on tranexamic acid for heavy periods show that it reduces blood loss but does not reduce the length of your period⁷. So tranexamic acid cannot be used to stop your period early once it has started.

Can I take tranexamic acid if I am breastfeeding?

Periods after you have given birth can be more heavy, and tranexamic acid can be used to manage these. Breastfeeding and tranexamic acid is safe. Just one hundredth of the amount of tranexamic acid a mother takes is passed to the baby through breast milk, and the manufacturer of tranexamic acid states this is unlikely to affect the baby⁹.

Where can I get tranexamic acid?

Until recently, tranexamic acid was only available from a healthcare professional on a prescription. Now, tranexamic acid can also be bought from a pharmacy under the brand name Evana without a prescription if you are aged between 18 to 49 with regular periods. 

Who is tranexamic acid not recommended for?

Some people are advised not to take tranexamic acid. This includes:

• People with severe kidney failure – this means tranexamic acid can’t be removed from the body easily
• People currently on treatment for a blood clot in the veins or arteries
• A previous blood clot in the veins or arteries or a family history of blood clots – although some doctors may prescribe tranexamic acid in certain situations under their supervision
• Previous seizures or convulsions – this is because high doses of tranexamic acid given as an injection in the vein have caused seizures.

Are there any side effects of tranexamic acid?

Tranexamic side effects have been studied since the 1970s, and it is good news. One of the very first research studies on tranexamic acid and heavy periods found no difference in side effects between women taking tranexamic acid compared to a placebo⁵. A more recent study found that 12% of women who used tranexamic acid for two menstrual cycles complained of digestive side effects such as nausea, vomiting, diarrhoea and heartburn, and in another study the most reported side effect was headache¹⁰.

The British National Formulary lists side effects of tranexamic acid as:

1. Common – diarrhoea, nausea, vomiting
2. Uncommon – allergic dermatitis
3. Rare or very rare – colour vision change, blood clots in the veins or arteries

Can tranexamic acid cause DVT?

DVT stands for deep vein thrombosis, which is a type of blood clot in the legs of the vein. There is a theoretical risk that tranexamic acid can increase the risk of blood clots, as it works by preventing your body from breaking down clots. No evidence was found of increased blood clots in the patients on tranexamic acid compared to those not on tranexamic acid after joint replacement surgery¹. However, it is still not recommended to take tranexamic acid if you have a personal or family history of blood clots.

Tranexamic acid and contraception

Tranexamic acid and the contraceptive pill

Tranexamic acid should not be used with the combined contraceptive pill, patch or ring. This is because combined contraception has a small increased risk of blood clots. Taking tranexamic acid alongside combined hormonal contraception could increase the risk of blood clots even more, so is not recommended.

Tranexamic acid and the copper coil

A side effect of the copper coil (copper IUD) is heavy bleeding. Tranexamic acid can be used to manage this side effect and has been shown to reduce the amount of blood loss in each period after a copper coil insertion, compared to not taking any medication¹¹.