What is the treatment for menometrorrhagia (abnormal uterine bleeding)?

From the Guidelines

Menometrorrhagia treatment should prioritize nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 600-800mg every 6-8 hours during bleeding, as well as hormonal treatments such as combined oral contraceptives or the levonorgestrel intrauterine system, according to the most recent guidelines 1.

Treatment Options

The treatment of menometrorrhagia should begin with a thorough evaluation to identify the underlying cause, which may include hormonal imbalances, structural abnormalities, or systemic conditions.

• First-line medical therapy typically includes NSAIDs, which reduce menstrual blood loss by 20-40% by decreasing prostaglandin production.
• Hormonal treatments are often effective, including combined oral contraceptives (containing estrogen and progestin) taken cyclically or continuously, which reduce bleeding by thinning the endometrium.
• Alternatively, the levonorgestrel intrauterine system (Mirena) provides localized progestin delivery, reducing menstrual blood loss by up to 90% within 3-6 months.

Specific Treatment Recommendations

According to the 2024 guidelines 1, treatment options for menometrorrhagia may include:

• NSAIDs for 5-7 days for spotting or light bleeding, or for heavy or prolonged bleeding.
• Hormonal treatment with low-dose COCs or estrogen for 10-20 days for heavy or prolonged bleeding.
• Antifibrinolytic agents, such as tranexamic acid, for 5 days for heavy or prolonged bleeding.

Considerations

It is essential to consider the patient's age, desire for future fertility, severity of symptoms, and underlying pathology when selecting a treatment option 1.

• If an underlying gynecologic problem is identified, treat the condition or refer for care.
• If bleeding persists or the woman finds it unacceptable, counsel on alternative contraceptive methods and offer another method, if desired.
• Iron supplementation (ferrous sulfate 325mg daily) is important to prevent or treat anemia resulting from chronic blood loss.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Therapy with norethindrone acetate tablets must be adapted to the specific indications and therapeutic response of the individual patient. Secondary amenorrhea, abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology 2. 5 to 10 mg norethindrone acetate tablets may be given daily for 5 to 10 days to produce secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen. INDICATIONS AND USAGE Norethindrone Acetate Tablets, USP are indicated for the treatment of secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as submucous fibroids or uterine cancer.

Treatment of Menometrorrhagia: Norethindrone acetate tablets may be used to treat abnormal uterine bleeding, including menometrorrhagia, due to hormonal imbalance in the absence of organic pathology. The recommended dosage is 2.5 to 10 mg daily for 5 to 10 days to produce secretory transformation of the endometrium 2.

• Key Points:
  • Dosage: 2.5 to 10 mg daily for 5 to 10 days
  • Indication: Abnormal uterine bleeding due to hormonal imbalance
  • Contraindication: Organic pathology, such as submucous fibroids or uterine cancer 2

From the Research

Treatment Options for Menometrorrhagia

The treatment of menometrorrhagia can be divided into several categories, including:

• Pharmaceutical agents, such as levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin, and non-steroidal anti-inflammatory drugs 3, 4, 5, 6, 7
• Surgical options, including endometrial curettage, endometrial ablation, hysterectomy, hysteroscopic polypectomy, and hysteroscopic myomectomy 3, 4, 5, 7
• Specific treatments for underlying causes, such as hysteroscopic resection of myomas or polyps, endometrectomy, and uterine arteries embolization 3, 4, 7

Pharmaceutical Agents

Pharmaceutical agents are often the first line of treatment for menometrorrhagia, with options including:

• Levonorgestrel intra-uterine device, which has been shown to be effective in reducing menstrual blood loss 3, 5, 6, 7
• Tranexamic acid, which can reduce menstrual blood loss by 20-60% 4, 5, 6, 7
• Estroprogestatif pills, oral progestin, and non-steroidal anti-inflammatory drugs, which can also be effective in reducing menstrual blood loss 3, 5, 6, 7

Surgical Options

Surgical options may be considered for women who do not respond to pharmaceutical agents or who have underlying conditions that require surgical intervention, including:

• Endometrial curettage, which can be used for women who desire pregnancy in the future 3
• Endometrial ablation, which can be used for women who no longer intend to get pregnant 3, 7
• Hysterectomy, which can be used as a last resort for women with severe menometrorrhagia or underlying conditions that require surgical intervention 3, 4, 7

Specific Treatments for Underlying Causes

Specific treatments may be necessary for underlying causes of menometrorrhagia, including:

• Hysteroscopic resection of myomas or polyps, which can be used to treat menometrorrhagia associated with uterine abnormalities 3, 4
• Endometrectomy, which can be used to treat menometrorrhagia associated with endometrial hyperplasia or cancer 4
• Uterine arteries embolization, which can be used to treat menometrorrhagia associated with uterine fibroids 3