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This meta-analysis aimed to perform a meta-analysis including randomized controlled trials (RCTs) to assess the efficiency and safety of tranexamic acid (TXA) for reducing blood loss and transfusion requirements in patients undergoing open myomectomy.A systematic search was performed in Medline (1966–2017.03), PubMed (1966–2017.03), Embase (1980–2017.03), ScienceDirect (1985–2017.03,) and the Cochrane Library. Study evaluated the efficiency and safety of TXA in myomectomy was selected. Meta-analysis was performed using Stata 11.0 software.Four RCTs including 328 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of total blood loss (standard mean difference [SMD] = −1.512, 95% confidence interval [CI]: −2.746 to −0.278, P = .016), postoperative hemoglobin level (SMD = 0.650, 95% CI: 0.045–1.255, P = .035), transfusion requirements (SMD = −0.102, 95% CI: −0.199 to −0.006, P = .038), and duration of surgery (SMD = −0.514, 95% CI: −0.749 to −0.280, P = .000). In addition, no adverse effect was identified in treatment groups.Intravenous administration of TXA in open myomectomy was associated with significantly reduced total blood loss, postoperative hemoglobin decline, duration of surgery, and transfusion requirements. Based on the limitations of the current meta-analysis, high-quality RCTs with long-term follow-up are still required.