DR JEN GUNTER: A 10p pill can relieve agonising period pain for millions of women… so why won’t doctors and pharmacists tell patients about it?

For around five days every month, some nine million British women are battling intense and enduring pain that leaves some unable to work, look after children and even move. 

I’m talking about period pains, or menstrual cramps, which are severe for two thirds of those who have a monthly bleed, according to the most recent polls.

As a gynaecologist, it’s my job to offer patients treatments that will help their condition and, ultimately, improve their quality of life. 

But when it comes to period pain, family doctors and other healthcare professionals don’t seem to be taking the same approach. 

Most women have never been told that there is a pill that can reduce the amount of blood loss by half, which cuts pain dramatically. 

Called tranexamic acid, it’s a tablet taken three times a day for up to four days, and is available both via prescription and over-the-counter.

It’s far cheaper on prescription, with GPs offering up to 60 tablets for £9.90, compared to a £15 pack of 18 tablets from Boots.

It’s also cheap-as-chips for the NHS, costing the health service less than ten pence per tablet.

But so few women know about it, because medical professionals rarely mention it, from what I hear from patients.

 And that’s exactly why I decided to write about it last week as part of my weekly newsletter, The Vajenda.

A 2023 report by the Wellbeing of Women charity found that half of women who suffer severe period pain feel healthcare professionals fail to take it seriously.

Most of this stems from the widely-held attitude that periods are ‘no big deal’ and women are ‘used’ to putting up with it. 

Dr Philippa Kaye, GP and resident This Morning doctor, agrees. ‘For far too long there’s been a perception in society that women have to put up with pain,’ she says. 

‘It’s not just that healthcare professionals might not be telling patients about the options available, but many women and girls won’t seek help in the first place.

‘They think being afraid to be far from a toilet while on their period is normal.’

But you don’t have to put up with it.

Not only are heavy, painful periods a nuisance, they can have serious consequences.   

That’s because a large amount of blood loss can lead to anemia, or iron deficiency.

Dr Jen Gunter is often described as the internet’s favourite gynaecologist, boasting 293K followers on Instagram.

Iron deficiency is a precursor to anemia, which is when a the depletion in iron results in a lack of healthy red blood cells, affecting energy levels, breathing, heart rate and a host of other bodily functions. 

But many women have their anemia dismissed as ‘not that bad’, or iron deficiency ignored altogether. 

However, iron deficiency is a medical condition in its own right and needs to be treated whether there is anemia or not.

Research shows that about 17 per cent of teens and women between the ages of 14 and 50 are iron deficient, primarily due to due to heavy menstrual bleeding. 

For girls and young women between the ages of 12 and 21, it’s a staggering 40 per cent. 

As heavier periods are more common during the menopause transition, iron deficiency should also be on the radar for anyone over age 40.

The symptoms of iron deficiency (see box below) overlap so much with those experienced by many women in the menopause transition, that I believe it’s essential for women with any of the above symptoms to be tested. 

If you aren’t menstruating, for example, because of a hysterectomy or a hormone IUD, the risk of iron deficiency is certainly less, but it’s still worth checking. 

There are a variety of therapies that can reduce menstrual blood loss including tranexmic acid. 

Tranexamic acid is available over the counter and is taken three times a day.

These include hormones, like The Pill and the IUD (or Mirena coil), as well as non-steroidal anti-inflammatory drugs or NSAIDs, like ibuprofen. 

However, many women don’t want to take hormones, and NSAIDs can’t be taken by a lot of people with certain underlying conditions.

They are also not as effective as tranexamic acid, studies show.

Tranexamic acid is a synthetic type of the amino acid lysine and reduces bleeding by slowing the body’s breakdown of blood clots. 

It is also used in other situations where bleeding is a concern, such as in some surgeries and as treatment of postnatal hemorrhage.

Tranexamic acid is taken three times a day during menstruation (each dose is usually two 500mg tablets). 

In studies, it reduces menstrual blood loss by up to 50 per cent compared with placebo.

Trial participants who take the medicine have what is considered a ‘clinically meaningful reduction in bleeding’, which essentially means most people find it very helpful.

There is a theoretical concern that tranexamic acid could increase the risk of dangerous blood clots in the lungs, but most studies haven’t shown this to be true.

Tranexamic acid has been over the counter in Sweden for over 20 years, where 1 per cent of menstruating people use the medication, and yet observational data has not identified an increased risk of clots. 

Other safety data comes from using tranexamic acid for postnatal bleeding. In one study, more than 10,000 women received the drug, and there was no increase in blood clots. 

However in Denmark, where researchers tracked the records of women prescribed tranexamic acid, a very small increased risk of blood clots was identified, meaning for every 78,549 women who take the medication for five days, one might have a blood clot. 

But given this is observational data, we don’t know if this is a true effect or an artifact, and proving this to be a true effect will be almost impossible given the number of people who would need to be enrolled in a clinical trial.

What does this mean for you? Most studies show no increased risk, but if there is one, it is likely very low–at most, about one in almost 80,000, which is considered very rare.

What about combining tranexamic acid with estrogen-containing oral contraception like the combined pill?

As estrogen-containing contraceptives do increase the risks of blood clots and stroke, it’s a reasonable question. 

According to the package labeling in the United States, ‘women using hormonal contraception should use tranexamic only if there is a strong medical need and the benefit of treatment will outweigh the potential increased risk of a blood clot.’

But it’s important to remember package labels are legal documents and don’t always align with evidence-based medicine for a variety of reasons. Also, the benefits of treatment should outweigh the risks for EVERY medication.

In one survey of obstetricians and gynaecologists in the US, where the medicine is only available on prescription, 64 per cent had prescribed tranexamic acid in conjunction with estrogen-containing contraceptives in the previous year.

Half of these medics said at least 50 per cent of the women who were treated this way had a resolution in their symptoms and only one reported a blood clot. 

Admittedly, this isn’t the most accurate way to get the data, but it’s clear many doctors are comfortable prescribing the two together. 

The potential risks need to be put in perspective because heavy bleeding can also have serious medical consequences.

In general, most experts don’t believe that combining tranexamic acid with estrogen-containing hormonal contraception significantly increases the risk of blood clots. 

However, if someone has other risk factors for blood clots in addition to taking an estrogen-containing contraceptive, that might require further discussions with a GP.

Those with a history of blood clots, or who are considered high-risk for clotting shouldn’t take tranexamic acid.

I suspect a lot of people with heavy bleeding could benefit from the drug, but are missing out because no one has told them about it.

Meanwhile, a medicine used to treat erectile dysfunction is somewhat of a household name.

The disparity is, well, peak patriarchy.