Original Report| Volume 32, ISSUE 3, P305-311, June 2019

An Open-Label, Single-Arm, Efficacy Study of Tranexamic Acid in Adolescents with Heavy Menstrual Bleeding

Published:February 04, 2019DOI:


      Study Objective

      Heavy menstrual bleeding (HMB) occurs in up to 40% of adolescent girls, significantly affecting their daily activities. Identifying alternative treatment strategies for HMB is particularly important for adolescents who prefer not to take hormonal contraception. Our objective was to determine whether use of tranexamic acid (TA) would increase health-related quality of life and decrease menstrual blood loss (MBL) in adolescents with HMB.

      Design, Setting, Participants, Interventions, and Main Outcome Measures

      In an open-label, multi-institutional, single-arm, efficacy study, patients 18 years of age or younger with HMB were treated with oral TA 1300 mg 3 times daily during the first 5 days of menses and monitored over the course of 4 menstrual cycles (1 baseline; 3 treatment cycles). Assessment of MBL was performed using the Menorrhagia Impact Questionnaire (MIQ) and the Pictorial Blood Assessment Chart. The MIQ includes Likert scale items, validated to assess the influence of HMB on quality of life. In previous studies, a 1-point decrease or more in score correlated with clinically significant improvement.


      Thirty-two patients enrolled in the study, and 25 had sufficient follow-up data to be deemed evaluable. The mean age of the participants was 14.7 years (range, 11-18 years). There was an overall improvement in all items of the MIQ, with a greater than 1-point improvement in the MIQ perceived blood loss scale. When using TA, mean Pictorial Blood Assessment Chart score improved by 100 points. There were no medication-related serious adverse events.


      Use of TA in female adolescents with HMB is well tolerated and leads to clinically meaningful reduction in MBL.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • James A.H.
        • Ragni M.V.
        • Picozzi V.J.
        Bleeding disorders in premenopausal women: (another) public health crisis for hematology?.
        Hematology Am Soc Hematol Educ Program. 2006; : 474
        • Fraser I.S.
        • Mansour D.
        • Breymann C.
        • et al.
        Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey.
        Int J Gynaecol Obstet. 2015; 128: 196
        • Cote I.
        • Jacobs P.
        • Cumming D.
        Work loss associated with increased menstrual loss in the United States.
        Obstet Gynecol. 2002; 100: 683
        • Pawar A.
        • Krishnan R.
        • Davis K.
        • et al.
        Perceptions about quality of life in a school- based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders.
        Haemophilia. 2008; 14: 579
        • Shankar M.
        • Chi C.
        • Kadir R.A.
        Review of quality of life: menorrhagia in women with or without inherited bleeding disorders.
        Haemophilia. 2008; 14: 15
        • Zia A.
        • Rajpurkar M.
        Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding.
        Thromb Res. 2016; 143: 91
        • Vo K.T.
        • Grooms L.
        • Klima J.
        • et al.
        Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent hematology clinic.
        Haemophilia. 2013; 19: 71
        • Pai M.
        • Chan A.
        • Barr R.
        How I manage heavy menstrual bleeding.
        Br J Haematol. 2013; 162: 721
        • Srivaths L.V.
        • Dietrich J.E.
        • Yee D.L.
        • et al.
        Oral tranexamic acid versus combined oral contraceptives for adolescent heavy menstrual bleeding: a pilot study.
        J Pediatr Adolesc Gynecol. 2015; 28: 254
        • Callender S.T.
        • Warner G.T.
        • Cope E.
        Treatment of menorrhagia with tranexamic acid. A double-blind trial.
        Br Med J. 1970; 4: 214
        • Bushnell D.M.
        • Martin M.L.
        • Moore K.A.
        • et al.
        Menorrhagia Impact Questionnaire: assessing the influence of heavy menstrual bleeding on quality of life.
        Curr Med Res Opin. 2010; 26: 2745
        • Janssen C.A.
        • Scholten P.C.
        • Heintz A.P.
        A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss.
        Obstet Gynecol. 1995; 85: 977
        • Zakherah M.S.
        • Sayed G.H.
        • El-Nashar S.A.
        • et al.
        Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin.
        Gynecol Obstet Invest. 2011; 71: 281
        • Sanchez J.
        • Andrabi S.
        • Bercaw J.L.
        • et al.
        Quantifying the PBAC in a pediatric and adolescent gynecology population.
        Pediatr Hematol Oncol. 2012; 29: 479
        • Lukes A.S.
        • Moore K.A.
        • Muse K.N.
        • et al.
        Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial.
        Obstet Gynecol. 2010; 116: 865
        • Wang W.
        • Bourgeois T.
        • Klima J.
        • et al.
        Iron deficiency and fatigue in adolescent females with heavy menstrual bleeding.
        Haemophilia. 2013; 19: 225
        • Johnson S.
        • Lang A.
        • Sturm M.
        • et al.
        Iron deficiency without anemia: a common yet under-recognized diagnosis in young women with heavy menstrual bleeding.
        J Pediatr Adolesc Gynecol. 2016; 29: 628
        • Sharma R.
        • Stanek J.R.
        • Koch T.L.
        • et al.
        Intravenous iron therapy in non-anemic iron-deficient menstruating adolescent females with fatigue.
        Am J Hematol. 2016; 91: 973
        • Lukes A.S.
        • Muse K.
        • Richter H.E.
        • et al.
        Estimating a meaningful reduction in menstrual blood loss for women with heavy menstrual bleeding.
        Curr Med Res Opin. 2010; 26: 2673
        • Shapley M.
        • Jordan K.
        • Croft P.R.
        Abnormal bleeding patterns associated with menorrhagia in women in the community and in women presenting to primary care.
        Fam Pract. 2007; 24: 532
        • Kulkarni R.
        Improving care and treatment options for women and girls with bleeding disorders.
        Eur J Haematol. 2015; 95: 2
        • Shapley M.
        • Jordan K.
        • Croft P.R.
        Why women consult with increased vaginal bleeding: a case-control study.
        Br J Gen Pract. 2002; 52: 108
        • National Institute for Health and Clinical Excellence
        Heavy Menstrual Bleeding.
        National Institute for Health and Clinical Excellence, London, England2007
        • Munro M.G.
        • Critchley H.O.
        • Fraser I.S.
        The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them?.
        Am J Obstet Gynecol. 2012; 207: 259
        • Kouides P.A.
        • Byams V.R.
        • Philipp C.S.
        • et al.
        Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid.
        Br J Haematol. 2009; 145: 212