Tranexamic Acid in the Treatment of Heavy Menstrual Bleeding: A Narrative Review of Efficacy and Safety

Background: Heavy menstrual bleeding (HMB) is a common gynaecological problem that may substantially impair quality of life and lead to health complications. Tranexamic acid (TXA) is a non-hormonal antifibrinolytic agent used during menstruation to reduce menstrual blood loss. Aim: This narrative review aims to summarize the role of TXA in the treatment of HMB, with particular emphasis on its mechanism of action, clinical efficacy, safety profile and limitations of the available evidence. Methods: A literature search was conducted in PubMed and Google Scholar, primarily including publications from 2010 to April 2026. Older studies were considered when historically important or widely cited. Randomised clinical trials, observational studies, systematic reviews, meta-analyses, narrative reviews, and clinical guidelines published in English were included. Data were synthesised narratively. Results: TXA reduces menstrual blood loss by inhibiting plasminogen activation and fibrin degradation, thereby stabilising fibrin clots within the endometrium. Oral TXA is typically used intermittently, only on days of menstrual bleeding. Evidence indicates that TXA is more effective than placebo and some pharmacological therapies in reducing menstrual blood loss and may improve bleeding-related quality of life. TXA is usually well tolerated, but thromboembolic risk should be assessed individually, especially in patients with risk factors. Conclusions: TXA is an effective and generally well-tolerated non-hormonal treatment for HMB. It does not replace diagnostic evaluation of the underlying causes of bleeding, and treatment should be individualised according to clinical risk factors, reproductive plans, and patient preferences. Further studies should assess high-risk populations and patient-reported outcomes.