INTRODUCTION Open abdominal myomectomy is a common gynaecological procedure that is associated with significant intraoperative haemorrhage. While tourniquet application is a useful haemostatic technique, the usefulness of tranexamic acid is less well established. However, evidence is lacking on the effectiveness of adjunctive tranexamic acid in combination with tourniquet. AIM AND OBJECTIVES The aim of this study was to compare the effect of combined pericervical tourniquet & intravenous tranexamic acid with pericervical tourniquet only on intraoperative blood loss, total blood loss, blood transfusion rate, haemoglobin concentration changes, duration of surgery, length of hospital admission and adverse events during open myomectomy. RESEARCH METHOD This was a two-centre randomized controlled trial conducted at two tertiary hospitals in Delta state. One-hundred and seventy-two consenting participants undergoing open myomectomy were randomly allocated to either the intervention arm (combined pericervical tourniquet & tranexamic acid; n=86) or the control arm (pericervical tourniquet only; n=86). The primary outcome measure was intra-operative blood loss; while secondary outcome measures were total blood loss, blood transfusion rate, haemoglobin concentration change, duration of surgery, length of hospital admission, and adverse events. Data were analyzed using statistical package for social sciences version 22. The randomization pattern was displayed on a flow chart. Comparison between the two study arms was conducted using Chi-Square test (or Fisher Exact test where applicable) for categorical variables, and the Student T test (or Mann-Whitney U-Test test when normal distribution cannot be assumed) for continuous variable. Level of statistical significance was set at 5% (P <0.05).