Tranexamic Acid Use in Heavy Menstrual Bleeding with Ocular Migraine History

Contraindications and Precautions

The American College of Cardiology recommends screening for absolute contraindications, including active thrombosis or disseminated intravascular coagulation, prior to prescribing tranexamic acid 1
The American Heart Association suggests that patients with cardiovascular disease, including spontaneous coronary artery dissection, should be cautious when using tranexamic acid 2, 1
The National Kidney Foundation advises that renal function assessment is mandatory for patients taking tranexamic acid, as impaired renal function increases the risk of neurotoxicity and ocular toxicity requiring dose reduction 1

The American College of Obstetricians and Gynecologists recommends a dosing regimen of 3.9-4 g per day orally for 4-5 days starting from the first day of menstruation for heavy menstrual bleeding 3
The Society of Family Planning recommends that tranexamic acid be taken only during active bleeding days, not continuously, to reduce menstrual blood loss by 34-60% 3

The American College of Obstetricians and Gynecologists suggests that the levonorgestrel-releasing intrauterine device (LNG-IUD) is more effective than tranexamic acid, reducing menstrual blood loss by 71-95% 2, 3
The American Academy of Family Physicians recommends NSAIDs, such as mefenamic acid or naproxen, as first-line alternatives to tranexamic acid, although they are less effective and should be avoided in patients with cardiovascular disease 3