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ABSTRACT Background: Menorrhagia is commonly known as prolonged (more than 7 days) or heavy (more than 80 ml) uterine bleeding occurring at regular intervals. Women with menorrhagia experience physical, social, and mental difficulties resulting from heavy bleeding. Aim and objectives: A prospective comparative study has been designed with the aim to compare the efficacy and quality of life in menorrhagia patients managed with tranexamic acid or mefenamic acid or tranexamic acid and mefenamic acid and to study the reduction in heavy menstrual bleeding. Methods: This prospective study was conducted at Kovai Medical Center and Research (KMCH) Coimbatore. Of 75 patients recruited for the study with randomization, 29 patients were in group A (Tranexamic acid), 14 patients were in group B (Mefenamic acid) and 33 patients were in group C (Tranexamic acid and mefenamic acid). Group A received Tranexamic acid 500mg, BD, from 1 to 5 days of the menstruation for three consecutive cycles. Group B received mefenamic acid 500mg, from 1 to 5 days, similarly group C received tranexamic acid and mefenamic acid 500mg, from 1 to 5 days of the menstruation for three consecutive cycles. PBAC score scale was used to assess the severity of bleeding. Quality of life questionnaires was used to compare the quality of life between groups. Results: Women between the age group of 41-45 years are mostly affected by heavy menstrual bleeding (HMB). PBAC mean score showed a significant reduction in menstrual blood loss in all three groups but combinational therapy of tranexamic acid and mefenamic acid proved to be more efficacious. Hb level in group C was seen to be increased slightly when compared with group A and group B. quality of life was improved in women treated with tranexamic acid and combinational drugs when compared to mefenamic acid. Conclusion: This study concluded that combinational therapy of tranexamic acid and mefenamic acid and monotherapy of tranexamic acid and mefenamic acid are effective in the management of menorrhagia. Tranexamic acid and mefenamic acid are superior to monotherapy of tranexamic acid and mefenamic acid in terms of effectiveness, reduction in blood loss, and improvement in quality of life.