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Peer-reviewedCC BY 4.0PLOS One

Tranexamic acid for anemia in women of reproductive age: A systematic review of randomized trials

  • Sima Berendes1
  • Katharine Ker2
  • Hilary O. D. Critchley
  • Raoul Mansukhani
  • Ian Roberts
  1. 1Clinical Trials Unit, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom
  2. 2Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom
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Abstract

Objective: The global target to halve the prevalence of anemia by 2025 has not been met. New strategies are needed. This systematic review examined the effect of tranexamic acid on anemia, menstrual health and wellbeing in women of reproductive age. Methods: We searched six databases from inception to 30 August 2025 and reference lists of seven related reviews. We included randomized trials comparing the effects of tranexamic acid with placebo or standard care on uterine bleeding. Eligible participants had normal menstrual bleeding or any type of non-pregnant abnormal uterine bleeding. Outcomes included hemoglobin concentration and anemia prevalence as the primary outcome, estimated blood loss, quality of life, thromboembolic events, and other adverse events. We conducted meta-analyses and assessed risk of bias (Cochrane risk-of-bias tool for randomized trials) and the certainty of evidence. Results: We included 17 trials in the review and 15 in the meta-analyses. None of the trials reported adequate data on hemoglobin concentration. For the anemia outcome, only one small trial contributed data (risk ratio 0.15, 95% confidence interval 0.01 to 2.74, very low certainty). Meta-analyses of secondary outcomes showed that tranexamic acid reduced objectively measured menstrual blood loss among women with heavy menstrual bleeding (6 trials, mean difference −47.0 milliliters, 95% confidence interval −56.6 to −37.4, I2 = 13%, moderate certainty) and in women with intrauterine devices (3 trials, mean difference −41.6 milliliters, 95% confidence interval −52.2 to −30.9, I2 = 64%, low certainty) and improved quality of life in women with heavy menstrual bleeding (2 trials, mean difference 0.5, 95% confidence interval 0.4 to 0.7, I2 = 0%, moderate certainty). The risk of nausea or vomiting was similar between groups (4 trials, risk ratio 1.0, 95% confidence interval 0.6 to 1.8, I2 = 0%, moderate certainty). Certainty of evidence for other outcomes ranged from very low to low, including for thromboembolic events, with only one event reported in the control arm of one trial. Conclusions: Tranexamic acid appears to reduce menstrual blood loss, but its impact on anemia is unclear. High-quality randomized trials of TXA for menstruating women with anemia are needed.

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Cite

BibTeXRIS
BibTeX
@article{berendes2026tranexamic,
  title = {{Tranexamic acid for anemia in women of reproductive age: A systematic review of randomized trials}},
  author = {Sima Berendes and Katharine Ker and Hilary O. D. Critchley and Raoul Mansukhani and Ian Roberts},
  journal = {PLOS One},
  year = {2026},
  month = nov,
  doi = {10.1371/journal.pone.0362488},
  url = {https://doi.org/10.1371/journal.pone.0362488},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Tranexamic acid for anemia in women of reproductive age: A systematic review of randomized trials
AU  - Sima Berendes
AU  - Katharine Ker
AU  - Hilary O. D. Critchley
AU  - Raoul Mansukhani
AU  - Ian Roberts
PY  - 2026
DA  - 2026/11/06
JO  - PLOS One
DO  - 10.1371/journal.pone.0362488
UR  - https://doi.org/10.1371/journal.pone.0362488
AB  - Objective: The global target to halve the prevalence of anemia by 2025 has not been met. New strategies are needed. This systematic review examined the effect of tranexamic acid on anemia, menstrual health and wellbeing in women of reproductive age. Methods: We searched six databases from inception to 30 August 2025 and reference lists of seven related reviews. We included randomized trials comparing the effects of tranexamic acid with placebo or standard care on uterine bleeding. Eligible participants had normal menstrual bleeding or any type of non-pregnant abnormal uterine bleeding. Outcomes included hemoglobin concentration and anemia prevalence as the primary outcome, estimated blood loss, quality of life, thromboembolic events, and other adverse events. We conducted meta-analyses and assessed risk of bias (Cochrane risk-of-bias tool for randomized trials) and the certainty of evidence. Results: We included 17 trials in the review and 15 in the meta-analyses. None of the trials reported adequate data on hemoglobin concentration. For the anemia outcome, only one small trial contributed data (risk ratio 0.15, 95% confidence interval 0.01 to 2.74, very low certainty). Meta-analyses of secondary outcomes showed that tranexamic acid reduced objectively measured menstrual blood loss among women with heavy menstrual bleeding (6 trials, mean difference −47.0 milliliters, 95% confidence interval −56.6 to −37.4, I2 = 13%, moderate certainty) and in women with intrauterine devices (3 trials, mean difference −41.6 milliliters, 95% confidence interval −52.2 to −30.9, I2 = 64%, low certainty) and improved quality of life in women with heavy menstrual bleeding (2 trials, mean difference 0.5, 95% confidence interval 0.4 to 0.7, I2 = 0%, moderate certainty). The risk of nausea or vomiting was similar between groups (4 trials, risk ratio 1.0, 95% confidence interval 0.6 to 1.8, I2 = 0%, moderate certainty). Certainty of evidence for other outcomes ranged from very low to low, including for thromboembolic events, with only one event reported in the control arm of one trial. Conclusions: Tranexamic acid appears to reduce menstrual blood loss, but its impact on anemia is unclear. High-quality randomized trials of TXA for menstruating women with anemia are needed.
SN  - 1932-6203
ER  -