Newly Approved Option for Nonhormonal Management of Heavy Menstrual Bleeding

The FDA has approved an oral fibrinolysis inhibitor, tranexamic acid (Lysteda), for treating women with heavy menstrual bleeding. In placebo-controlled trials, this agent was associated with substantially less menstrual blood loss. Adverse effects included headaches, sinus pain, muscle and joint pain, anemia, and fatigue. The FDA also noted that tranexamic acid might raise risk for thrombosis; therefore, women who use hormonal contraception should use tranexamic acid only for strong medical indications for which benefits would outweigh risks. The approved dose is two 650-mg tablets three times daily (i.e., 3900 mg daily) for ≤5 days during menstruation.