Background: Abnormal uterine bleeding (AUB) is a prevalent gynecological condition that significantly affects women’s physical health, psychological well-being, and quality of life. It is a major contributor to iron deficiency anemia and often requires long-term medical management. Tranexamic acid (TXA), a non-hormonal antifibrinolytic agent, is widely used for reducing menstrual blood loss in AUB. Objective: This study aimed to assess the clinical bleeding patterns in women with abnormal uterine bleeding and to evaluate associated anemia and thyroid dysfunction, quantify menstrual blood loss using PBAC scoring, and determine the efficacy of tranexamic acid in reducing blood loss and improving quality of life & clinical outcomes. Methods: A prospective observational study was conducted for six months in the Department of Obstetrics and Gynecology, among women diagnosed with AUB attending a tertiary care teaching hospital. Data regarding demographic characteristics, bleeding patterns, menstrual cycle parameters, hemoglobin levels, thyroid status, and comorbidities were collected. The effectiveness of tranexamic acid was evaluated over a four-month treatment period using the Pictorial Blood Loss Assessment Chart (PBAC) and quality of life (QoL) assessment scores. Pre- and post-treatment outcomes were statistically compared. Results: Menorrhagia was the most frequently observed bleeding pattern among the study population. A considerable number of patients had iron deficiency anemia and thyroid dysfunction, predominantly hypothyroidism. Treatment with tranexamic acid resulted in a significant reduction in menstrual blood loss, reflected by decreased PBAC scores. Improvements were also noted in hemoglobin levels, menstrual cycle regularity, and quality of life parameters. Tranexamic acid was well tolerated, with no serious adverse effects reported. Conclusion: Tranexamic acid is a safe, effective, and well-tolerated non-hormonal therapeutic option for the management of abnormal uterine bleeding. Early diagnosis and appropriate medical intervention can significantly reduce disease burden and enhance quality of life.