From the Guidelines
The management of uterine bleeding should prioritize hemodynamic stabilization with IV fluids and blood transfusions if necessary, followed by hormonal therapies such as combined oral contraceptives or IV conjugated estrogens, and non-hormonal options like NSAIDs or tranexamic acid, with the choice of treatment individualized based on the underlying cause, the woman's age, desire for fertility, and comorbidities. The most recent and highest quality study 1 suggests that medical therapy with either oral contraceptive medication or gonadotropin-releasing hormone (GnRH) agonists or antagonists can be effective in managing bleeding symptoms, especially in women with small fibroids. Some key points to consider in the management of uterine bleeding include:
- Identifying and treating any underlying gynecological problems, such as interactions with other medications, an STD, pregnancy, or new pathologic uterine conditions (e.g., polyps or fibroids) 1
- Using NSAIDs for short-term treatment (5–7 days) or hormonal treatment (if medically eligible) with low-dose COCs or estrogen for short-term treatment (10–20 days) 1
- Considering alternative contraceptive methods if bleeding persists and the woman finds it unacceptable 1
- Using tranexamic acid (1000-1300 mg three times daily for up to 5 days during bleeding) to reduce blood loss by inhibiting fibrinolysis 1
- Considering surgical interventions such as endometrial ablation or hysterectomy for women who have completed childbearing and have failed medical therapy 1