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Who can take Evana®?

Evana can be recommended for women aged 18–45 years with HMB who have regular menstrual cycles (21–35 days duration) where the length of their cycle does not vary by more than 3 days from month to month.6 

How to take Evana® for HMB? 

Evana should only be taken once heavy menstrual bleeding has started, for a maximum of 4 days. The recommended dosage is6:

  • Two tablets to be taken 3 times a day (eg. morning, afternoon and evening), as long as needed
  • If menstrual bleeding isn't reduced, an extra 2 tablets can be taken at night – but no more than 8 tablets (4 g) should be taken per day
  • Evana can be used for as long as the woman’s periods remain regular and heavy6 
  • However, if the patient has taken Evana as directed for three menstrual cycles and there has been no reduction in their HMB, then they should seek further advice from their doctor. 6 Their doctor may recommend an alternative non-hormonal treatment, such as the off-licence use of an NSAID, or a hormonal option, with levonorgestrel intrauterine system (LNG-IUS) and combined hormonal contraceptives or cyclical oral progestogen.2

Who cannot take Evana®?

The following patients cannot take Evana6: 

  • Under 18 years of age
  • With irregular menstrual bleeding – more than 3 days variability per 21–35 day cycle
  • Taking oral contraceptives, as this can increase the risk of thrombosis
  • Taking warfarin or other anticoagulants
  • Mild-to-moderate renal insufficiency or severe renal impairment
  • Active thromboembolic disease, or a previous thromboembolic event and a family history of thrombophilia
  • Blood in the urine (haematuria)
  • Fibrinolytic conditions following disseminated intravascular coagulation
  • History of convulsions
  • Hypersensitivity to tranexamic acid or any of the tablet excipients. These are - Calcium hydrogen phosphate, croscarmellose sodium, povidone, talc, and magnesium stearate
  • Pregnant women.

Who needs to take care when considering Evana®?

Evana may need to be used with caution in certain patients. You can advise the following patients on the suitability of Evana for their HMB or recommend that they speak to their doctor before taking Evana6.

  • Over 45 years of age
  • Obese patients (Body Mass Index (BMI) of 30 or above)
  • Diabetics
  • Those with polycystic ovary syndrome
  • History of endometrial cancer in a first-degree relative (e.g., mother, grandmother, aunt, or sister)
  • Those taking unopposed oestrogen or tamoxifen, or fibrinolytic medicines such as streptokinase
  • Breastfeeding women – a small amount passes into breastmilk but an antifibrinolytic effect in the infant is unlikely.
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  • When should you refer the patient to a doctor?

    The following patients with HMB should be referred to their doctor for further investigation if they9,11:

    • Have severe pain during their period
    • Experience bleeding between periods or after sex
    • Experience pain when having sex, micturition or passing stools
    • Have a pelvic mass with unexplained bleeding or weight loss
    • Are over 55 years of age and experiencing post-menopausal bleeding
    • Have ascites (abnormal fluid collection in the abdomen) and/or pelvic or abdominal mass
    • Have iron deficiency anaemia that is not responding to iron supplementation
    • Have HMB that is not improving with OTC treatments.
  • Drug Interactions

    Patients taking the following medications should not take Evana6: 

    • Oral contraceptives, as this can increase the risk of thrombosis 
    • Warfarin or other anticoagulants

    Discuss the suitability of Evana or advise the patient to speak to their doctor before taking Evana if they are taking 

    • Unopposed oestrogen or tamoxifen
    • Fibrinolytics e.g., streptokinase
  • Possible Side Effects

    Like all medicines this medicine can cause side effects, although not everybody gets them.

    Side effects with Evana may include6:

    • Gastrointestinal discomfort, such as nausea, vomiting and diarrhoea, are the most common adverse effects (may affect up to 1 in 10 people), however, these resolve when the dosage is reduced
    • Uncommon (may affect up to 1 in 100 people): allergic skin reactions 
    • Very rare (may affect up to 1 in 10,000 people): hypersensitivity reactions including anaphylaxis 
    • Frequency not known: thromboembolic events, retinal/artery occlusion, impaired colour vision or other visual disturbances have been reported. 

    Seizures can occur, particularly in cases of misuse. The patient should be advised to stop taking Evana if they experience any visual disturbances.6

  • Understanding the pharmacy supply of Evana

    Evana is only available from pharmacies following a consultation with a pharmacist. We recommend that you utilise the Evana checklist as a reminder of the various factors to consider when making a treatment recommendation.