Tranexamic acid and naproxen OTC

Heavy menstrual bleeding (HMB) and period pain were highlighted this year with the launch of OTC tranexamic acid (Evana) and naproxen 250mg products. The impact of primary dysmenorrhoea on daily life is often underestimated. Michelle Obama’s tweet “Why are girls still  missing so many days of school because of their menstrual cycles?” struck a chord with many people.

Dysmenorrhoea is the main reason for girls and young women to miss days at school or work but is frequently and wrongly dismissed as being a normal part of growing up. 

Non-steroidal antiinfl ammatory drugs (NSAIDs) are known to work in over 80 per cent of cases of primary dysmenorrhoea. They work by reversibly inhibiting the COX-1 and COX-2 enzymes involved in prostaglandin production.

NICE guidance recommends NSAIDs, such as naproxen or ibuprofen, as the first-line treatment for period pain. A new naproxen 250mg OTC product was launched in 2024. Ultravana is a gastroresistant tablet (which should not be crushed) that aims to reduce GI side effects by disintegrating after the tablet has left the stomach. The dose is two tablets initially and then one tablet after six to eight hours if required, up to a maximum of three a day. As with any OTC NSAID, it is important to ask about  previous use of aspirin or NSAIDs and any sensitivity to the drug, as well as asking about asthma (around seven per cent of people with asthma, rising to 15 per cent in severe asthma, experience what is now referred to as aspirinexacerbated respiratory disease with crosssensitivity with NSAIDs). The use of NSAIDs more generally in dysmenorrhoea has been shown to be affected when side effects are experienced, so for standard tablet formulations, advice and reinforcement of the need to avoid taking ‘on an empty stomach’ is particularly important, with more explanation in practical terms, as some people interpret ‘take it with food’ as only taking after a full meal. A smaller snack or glass of milk or juice may be enough to avoid irritating the stomach.