From the FDA Drug Label
ADVERSE REACTIONS • Menstrual irregularity is the most frequently reported side effect. • Frequent and irregular bleeding are common, while long duration of bleeding episodes and amenorrhea are less likely.
The FDA drug label does not answer the question.
From the Research
The most effective treatment for heavy menstrual bleeding is the levonorgestrel-releasing intrauterine system (LNG-IUS), which has been shown to reduce menstrual blood loss by up to 90%. According to the study by 1, the LNG-IUS is more effective than other medical therapies, including cyclical progestogens, in reducing heavy menstrual bleeding. The study found that the LNG-IUS may improve heavy menstrual bleeding, lowering menstrual blood loss, and probably leads to slightly higher quality of life compared to other medical therapy.
When considering progestin-only pills (POPs) for heavy menstrual bleeding, desogestrel 75 mcg (Cerazette) is a viable option, taken continuously without breaks, as it has stronger endometrial suppression effects compared to other progestins, which helps reduce menstrual bleeding 2. However, it is essential to note that the LNG-IUS is a more effective treatment option for heavy menstrual bleeding.
The study by 2 compared different types and regimens of oral progestogens in reducing ovulatory heavy menstrual bleeding and found that long-cycle progestogen therapy may be similar to the combined vaginal ring with respect to reduction of menstrual blood loss. However, the evidence supporting these findings was limited by low or very low gradings of quality.
In terms of combined hormonal contraceptives, the study by 3 found that the combined oral contraceptive pill (COCP) improved response to treatment and lowered menstrual blood loss when compared to placebo. However, the COCP was less effective than the LNG-IUS in reducing heavy menstrual bleeding.
Key points to consider when treating heavy menstrual bleeding include:
- The LNG-IUS is the most effective treatment option, reducing menstrual blood loss by up to 90%
- Desogestrel 75 mcg (Cerazette) is a viable POP option, taken continuously without breaks
- Combined hormonal contraceptives, such as the COCP, may also be effective in reducing heavy menstrual bleeding, but are less effective than the LNG-IUS
- It is essential to consider the individual patient's needs and medical history when selecting a treatment option for heavy menstrual bleeding.