Background: Open myomectomy remains the main option has been shown to have the satisfactory result as regard fertility preservation and symptom resolution with especially when the number and size of leiomyomas do not permit any other surgical rout of the surgery. The aim of this work was to reducing blood loss during myomectomy using either intravenous or topical method. Methods: This randomized controlled trials included 60 Patients who undergo abdominal myomectomy with myoma staging from (3 to 6) according to FIGO staging divided into three groups each group comprised of 20 patients. Group I: received 110 ml normal saline intravenous just before skin incision. Group II: 1g tranexamic acid intravenous just before skin incision. Group III: received 2g topical tranexamic acid applied on myoma bed after myomectomy collected from the Department of Obstetrics and Gynecology, at Zagazig University Hospital during the period from year October 2019 to April 2020. The primary outcome was intra-operative, postoperative and all blood loss estimation. Results: there was statistically significant difference between the studied groups regarding blood loss with higher blood loss either intraoperative, postoperative and overall blood loss on control than topical than intra venous tranxamic acid group (p-value= 0.8, 0.9 and 0.9) respectively. Regarding need for blood transfusion where (50.0%) of the control group needed blood transfusion while only (10.0%) of intravenous and topicaltranexamic acid groups needed blood transfusion (p-value= 0.003*). Conclusions: Intravenous and topical tranexamic acid safe and reliable method to help decrease blood loss during open myomectomy without serious side effects.