Tranexamic Acid to Reduce Contraceptive-related Bleeding Side Effects

Inclusion criteria

• English or Spanish speaking
• In good general health
• Have etonogestrel (ENG) subdermal contraceptive implant (must be palpable to prove that an ENG implant is in place at time of screening and enrollment)
• Experience frequent or prolonged bleeding while using ENG implant (>7 days of continuous bleeding/spotting in the last 30 days, or 2 or more episodes of bleeding/spotting in the last 30 days)
• Implant use for at least 30 days prior to screening visit
• Willing to continue using the implant for at least 30 days from study enrollment
• Access to a reliable cell phone and must be willing to receive and respond to a daily text or email message to assess bleeding and use of study drug
• Negative gonorrhea/chlamydia screening performed at screening visit

Exclusion criteria

• Centers for Disease Control Medical Eligibility for Contraceptive use category 3 or 4 for contraceptive usage
• Currently pregnant
• Less than 6 months postpartum, less than 6 weeks abortion, not breast/chest feeding (cessation of lactation at least 6 weeks prior to enrollment)
• Undiagnosed abnormal uterine bleeding pre-dating placement of contraceptive implant
• Bleeding dyscrasia
• Anticoagulation use
• Active cervicitis
• Allergy to Tranexamic Acid
• Known renal insufficiency
• History of venous thromboembolism
• Current or past breast or uterine malignancy
• Concurrent use of P450 pathway inducing drug
• Implant is due to be switched out in 2 months or less from enrollment
• Routine or chronic use of non-steroidal anti-inflammatory drugs (NSAIDs once daily or >= 14 days per month)
• Currently using oral contraceptives in addition to implant (to be eligible, needs to have 4-6 week washout period)
• Prior pregnancy occurred while Nexplanon/Implanon was in place
• Chronic use of Cannabidiol, THC, or marijuana (>3 times per week) (patients could have used Cannabidiol, THC, or marijuana chronically in the past, but must have a washout time period of no use for at least one month prior to the study)
• Chronic use of cigarettes (>1 cigarette per week) (patients could have used cigarettes chronically in the past, but must have a washout time period of no use for at least six months prior to the study)