An expert review and commentary on the efficacy and safety of tranexamic acid for the treatment of heavy menstrual bleeding

Heavy menstrual bleeding (HMB) seriously impacts physical and mental well-being of many women during their lifetimes. Many women turn to primary care providers or gynecologists seeking relief and resort to invasive surgical procedures such as endometrial ablation and/or hysterectomy. Pharmaceutical agents (e.g., progestogens, combined oral contraceptives, nonsteroidal anti-inflammatory drugs, hormone-releasing intrauterine devices and hemostatic agents) are all options for women who wish to avoid risks inherent to surgery, maintain fertility and limit the potential for early onset of menopausal symptoms. The response to these agents can be unpredictable and may depend on clinical- and patient-related factors. Agents with a contraceptive effect are not appropriate for women wishing to conceive. Tranexamic acid, an antifibrinolytic, has been used worldwide for over 50 years to effectively treat HMB, but a modified immediate-release formulation was only recently approved in the USA as the only approved treatment option for HMB compatible with fertility and conception.