From the Guidelines
To stop a uterine bleed, medical management with hormonal medications, such as combined oral contraceptives or tranexamic acid, is usually the first line of treatment, and in most cases, medical management should be trialed prior to pursuing more invasive therapies. For minor bleeding, rest and take over-the-counter pain relievers like ibuprofen (400-600mg every 6 hours) or naproxen (220-440mg every 12 hours), which can reduce both pain and blood flow 1.
Treatment Options
- Hormonal medications, including combined oral contraceptives, progesterone-only pills, or tranexamic acid (Lysteda, typically 1300mg three times daily during heavy bleeding) are often prescribed to stabilize the endometrium and promote blood vessel constriction, while tranexamic acid prevents the breakdown of blood clots, allowing them to form more effectively and reduce bleeding 1.
- In emergency situations, healthcare providers may administer intravenous estrogen, perform uterine artery embolization, or use intrauterine balloon tamponade.
- For chronic bleeding, options include hormonal IUDs like Mirena, endometrial ablation, or hysterectomy in severe cases.
Underlying Conditions
It is essential to consider an underlying gynecological problem, such as interactions with other medications, an STD, pregnancy, or new pathologic uterine conditions (such as fibroids or polyps), and treat the condition or refer for care if identified 1.
Recent Guidelines
According to the most recent guidelines, medical management or uterine artery embolization (UAE) is usually appropriate for the initial therapy for a reproductive age patient with uterine fibroids and concurrent adenomyosis, symptomatic with heavy uterine bleeding or bulk symptoms 1.
From the Research
Medical Management of Uterine Bleeding
To stop a uterine bleed, medical management is often the first-line approach, as stated in the study 2. The treatment options vary depending on the acuity of the bleeding, the patient's medical history, and the underlying cause of the bleeding.
Treatment Options
Some viable options for treating abnormal uterine bleeding include:
- Parenteral estrogen
- Multidose combined oral contraceptive regimen
- Multidose progestin-only regimen
- Tranexamic acid, as mentioned in the studies 2 and 3
- Levonorgestrel-releasing intrauterine system
- Combined oral contraceptives
- Continuous oral progestins
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease menstrual bleeding, as stated in the study 2
- Gonadotropin-releasing hormone agonists for patients with leiomyoma and abnormal uterine bleeding, as mentioned in the study 2
Progesterone and Progestogens
Progesterone and progestogens play a significant role in regulating intermenstrual bleeding and decreasing heavy menstrual bleeding, as discussed in the study 4. Medroxyprogesterone acetate (MPA) is a progestogen that can be used to treat abnormal uterine bleeding due to ovulatory dysfunction, as shown in the study 5. The study 5 found that a 10-day cyclic use of MPA was more effective in regulating the menstrual cycle and stopping abnormal uterine bleeding than a 15-day protocol.
Tranexamic Acid
Tranexamic acid (TXA) is another effective option for managing dysfunctional uterine bleeding, as demonstrated in the study 3. The study 3 compared the efficacy and safety of TXA with medroxyprogesterone acetate (MPA) and found that TXA was more effective in reducing blood loss and had a lower rate of lack of response during treatment.
Emergency Department Management
In emergency situations, it is essential to have a comprehensive understanding of the pathophysiology and etiologies of abnormal uterine bleeding to manage and treat patients effectively, as emphasized in the study 6. Emergency clinicians should be aware of the common causes of abnormal uterine bleeding and the approach to managing these patients in the emergency department.