Menorrhagia on Warfarin — RACP Adult Medicine MCQ

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ModerateHaematologyMenorrhagia on WarfarinRACP Adult Medicine

A 55-year-old woman on warfarin for a mitral mechanical valve develops menorrhagia. Her INR is consistently in the therapeutic range (2.5–3.5). What is the most appropriate management of her menorrhagia?

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Correct answer: B — Tranexamic acid for menorrhagia

Tranexamic acid is an antifibrinolytic agent that is safe and effective for managing menorrhagia in patients on anticoagulation. It works locally on the endometrial fibrinolytic system without significantly increasing systemic thrombotic risk. The combination with warfarin is considered acceptable. The INR target for a mitral mechanical valve (2.5–3.5) should NOT be reduced as this increases valve thrombosis risk. OCP is relatively contraindicated with mechanical valves and anticoagulation.

Reference: AMH – 2025 – Tranexamic Acid; eTG – 2025 – Haematology