Tranexamic acid side effects and dosage for heavy periods

Tranexamic acid, known in the Netherlands as Cyklokapron, reduces heavy menstrual bleeding without hormones. You take it only on your heaviest bleeding days, usually 1000 mg 3 to 4 times a day for up to 4 days. Tranexamic acid side effects are mainly gastrointestinal: nausea, diarrhoea and sometimes headache.

This is the only drug in this series that does nothing to your hormones, and that makes it distinctive. For women trying to conceive, or women who are done with hormones, that is often exactly the point.

What is tranexamic acid and how does it work?

Tranexamic acid is an antifibrinolytic. It slows the breakdown of clots by blocking plasminogen, the protein that normally dissolves them. In your womb lining that breakdown is very active during a period, and that is part of why some women lose so much blood.

By slowing that breakdown the clot stays intact longer and bleeding decreases. So the drug does not thicken your blood and it does not stop your period: it only reduces the volume.

Because it does nothing to oestrogen or progesterone, your cycle stays intact and you keep ovulating. You can become pregnant while using it.

Tranexamic acid dosage for periods

You start on the day heavy bleeding begins, not preventively days before. The schedule runs for as long as bleeding is heavy, with a usual maximum of 4 days per cycle. The doses below come from the patient leaflet and the Dutch Farmacotherapeutisch Kompas.

Your doctor adjusts the dose with reduced kidney function, because tranexamic acid is cleared through the kidneys. Also mention any other medication you take, certainly oestrogen-containing contraception or blood thinners.

Tranexamic acid experiences: what do users report?

The stories are honestly mixed, which fits what the drug does. It is not an all-or-nothing solution: it reduces bleeding, and by how much differs greatly per woman and per cause.

What comes back positively:

• Clearly less leaking through, making work and exercise possible again
• Fewer large clots on the heaviest days
• No hormones, so no effect on mood or libido
• You only take it a few days a month

What women find difficult:

• Nausea and diarrhoea, especially at 4 doses a day
• For some, the effect fades over the months
• Worry about thrombosis, often triggered by the word clotting in the explanation
• The number of tablets: 6 to 8 a day feels like a lot
• With an underlying cause such as fibroids, the gain stays limited

Picture two women of 41 who both get tranexamic acid. One loses noticeably less blood and stays on it for years. The other improves for the first months, then gets large clots again; in her case fibroids turn out to be the cause. The same drug, and for the second the answer was not a higher dose but a scan.

Side effects of tranexamic acid

The side effects reported most are nausea, vomiting and diarrhoea. They are dose-dependent: many women tolerate 3 doses a day better than 4. Taking it with some food often helps, and headache and dizziness also occur.

The question almost everyone asks is about thrombosis. Tranexamic acid slows the breakdown of clots, so that concern makes sense. In women without raised risk, use for heavy periods has not been clearly associated with more thrombosis in research, but the drug is avoided if you have had a thrombosis or have a known clotting disorder.

Get in touch about a painful swollen leg, breathlessness, chest pain or changes in your vision. Discuss it beforehand if you use oestrogen-containing contraception, as that slightly raises clot risk on its own.

How much less bleeding can you expect?

The honest answer is: less, but rarely none. A 2018 Cochrane review of antifibrinolytics for heavy menstrual bleeding found a clear reduction compared with placebo, and a larger reduction than with NSAIDs or oral progestogens in the treated cycles (PMID 29656433).

A broader Cochrane overview from 2022 compared all treatments for heavy menstrual bleeding side by side. The hormonal coil came out as the most effective option, with tranexamic acid as a strong non-hormonal choice (PMID 35638592). Cyclical progestogens scored differently again in a separate review (PMID 31425626).

What that means in practice: expect a noticeable reduction, not a light period. For many women that is exactly enough to make the difference between getting to the office and not.

Do not forget your ferritin

Here is the blind spot, as we see it. Reducing the bleeding is half the job; the iron store that bleeding has already used up is the other half. Those two are often treated separately, which is a shame.

Ferritin falls before your haemoglobin does. So you can have a normal Hb and still be exhausted, with a ferritin of 10 or lower. Rebuilding that store takes months, even once the bleeding is lighter from now on.

You can have your ferritin tested to see where you stand, with an assessment by a BIG-registered doctor. Also read about iron deficiency without anaemia and about anaemia from heavy periods. The reference values are at ferritin.

When do you look beyond the bleeding itself?

Tranexamic acid treats the symptom, and that is allowed. But when heavy bleeding is new, or increasing, the question of where it comes from belongs with it.

Common causes are fibroids, polyps, adenomyosis, an underactive thyroid, and clotting disorders such as Von Willebrand disease, which is more common in women with heavy periods than many people think. Our guides to heavy periods and when testing is useful and to fibroids set them out.

Thuisarts.nl describes when to see your GP about heavy bleeding, which is good preparation for that conversation.

Alternatives to tranexamic acid

The choice depends mostly on whether hormones are an option for you, and whether you want to conceive.

• A hormonal coil, the most effective option for heavy bleeding in research
• Primolut N or another cyclical progestogen
• NSAIDs such as ibuprofen or naproxen, which also reduce period pain
• A combined pill, which keeps the lining thin
• With a demonstrable cause: treating that cause, for example fibroids

Tranexamic acid combines well with an NSAID, because they act at different points. Do discuss that combination with your doctor or pharmacist.

Frequently asked questions

How long can you use tranexamic acid?

Four days per cycle is usual, only on the heavy bleeding days. Repeating it each cycle can continue long term, in consultation with your doctor. If you notice little difference after three cycles, discuss whether another route suits you better.

How much tranexamic acid per day for periods?

Usual is 1000 mg, so 2 tablets of 500 mg, 3 to 4 times a day. The maximum daily dose is 4000 mg. Spread the doses through the day and take them with some food to limit nausea.

Is tranexamic acid the same as Cyklokapron?

Cyklokapron is the brand name, tranexamic acid is the active substance. Generic tablets with the same substance and dose also exist. For the effect that makes no difference.

Can you get tranexamic acid without a prescription?

In the Netherlands tranexamic acid for heavy periods needs a prescription. You sometimes find online references to chemists, but those nearly always concern other products. Ask your GP for a prescription.

Does tranexamic acid affect your fertility?

No, the drug does not act on your hormones and does not suppress ovulation. Your cycle stays intact and conceiving remains possible. If you are pregnant or suspect you might be, check before using it.

Tranexamic acid is one of the few options for heavy bleeding that leaves your hormones completely alone, which makes it the logical first step for many women. Just pair it with one extra action: get your ferritin measured before you conclude that your tiredness is simply part of life. That number often changes more than the drug itself.

Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.

References

• Farmacotherapeutisch Kompas. Tranexamic acid. Accessed 2026.
• Thuisarts.nl. I have heavy bleeding with my period. Accessed 2026.
• Bryant-Smith AC, Lethaby A, Farquhar C, Hickey M. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database of Systematic Reviews, 2018. PMID 29656433.
• Bofill Rodriguez M, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database of Systematic Reviews, 2022. PMID 35638592.
• Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database of Systematic Reviews, 2019. PMID 31425626.