From the Guidelines
Increasing estrogen and oral contraceptive pills (OCPs) can effectively help manage heavy menstrual bleeding, with combined hormonal contraceptives being a first-line treatment option. The most recent and highest quality study 1 suggests that oral contraceptives may manage bleeding symptoms effectively, especially in women with small fibroids.
Key Points to Consider
- Combined hormonal contraceptives containing both estrogen and progestin, such as pills like Yaz, Yasmin, or Loestrin, are effective in managing heavy bleeding by thinning the endometrial lining and making periods lighter and more predictable.
- For acute heavy bleeding, higher estrogen doses may be used temporarily, such as monophasic OCPs containing 30-35 mcg of ethinyl estradiol taken 2-4 times daily for a few days, then tapered to once daily.
- For long-term management, standard OCP dosing (one pill daily) is typically sufficient, with the mechanism involving estrogen stabilizing the endometrial lining while progestin prevents excessive growth, resulting in lighter, more controlled bleeding.
- Treatment usually leads to improvement within 2-3 menstrual cycles, with side effects including nausea, breast tenderness, and headaches, which often improve after the first few months.
- Women with contraindications to estrogen, such as history of blood clots, certain migraines, or specific cardiovascular conditions, should consider progestin-only options instead, as suggested by 1 and 1.
Important Considerations
- The use of OCPs has been shown to have non-contraceptive benefits, including decreased menstrual cramping and blood loss, and improvement in acne, as noted in 1.
- Extended or continuous cycles of OCPs may be useful for treating medical conditions such as anemia, severe dysmenorrhea, endometriosis, dysfunctional or heavy menstrual bleeding, and Von Willebrand disease, as well as for adolescents who prefer amenorrhea, as mentioned in 1.
From the Research
Heavy Menstrual Bleeding Treatment Options
- Heavy menstrual bleeding (HMB) is a common complaint among reproductive-aged women, which negatively affects their health as well as their social, professional, and family lives 2.
- The effectiveness of treatments to reduce HMB due to endometrial dysfunction in descending order was as follows:
- the levonorgestrel-releasing intrauterine system (LNG-IUS)
- combined hormonal contraceptives (oral or transvaginal)
- tranexamic acid
- long-course oral progestogens (≥3 weeks per cycle) 2.
Role of Estrogen and OCP in Reducing Heavy Bleeding
- Combined hormonal contraceptives, which contain estrogen and progestogen, are effective in reducing HMB 2, 3, 4.
- Oral contraceptive pills (OCP) can reduce menstrual blood loss, but the evidence of their effectiveness compared to other treatments is limited and of low to moderate quality 5.
- Estrogen therapy is not explicitly mentioned as a standalone treatment for HMB in the provided studies, but it is a component of combined hormonal contraceptives, which are used to treat HMB.
Comparison of Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce HMB when compared with placebo, but are less effective than tranexamic acid, danazol or LNG-IUS 5.
- There was no clear evidence of difference between NSAIDs and other medical treatments such as oral luteal progestogen, ethamsylate, OCP or the older progesterone-releasing intrauterine system 5.
- The levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line medical therapy for HMB, with combined hormonal contraceptives as second choice 2.