From the Guidelines
The treatment for increased frequency of menstruation should start with exploring patient goals and considering an underlying health condition, followed by treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents, as recommended by the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1. The initial step in managing increased frequency of menstruation involves evaluating the patient's goals, including continued use of their current contraceptive method or discontinuation, and exploring any underlying health conditions that may be contributing to the bleeding irregularities, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions like polyps or fibroids 1. Some key treatment options for increased frequency of menstruation include:
- NSAIDs, such as ibuprofen, for 5-7 days to reduce prostaglandin production and alleviate bleeding symptoms 1
- Hormonal treatment, including combined oral contraceptives or estrogen, to regulate menstrual cycles and reduce bleeding 1
- Antifibrinolytic agents, such as tranexamic acid, for 5 days to inhibit fibrinolysis and decrease bleeding 1 It is essential to consider the patient's preferences, treatment goals, and medical history when selecting a treatment option, and to provide reassurance and advise the patient to contact their provider if they experience any bleeding irregularities or other side effects 1. If the patient desires removal or discontinuation of their current contraceptive method, it is crucial to remove the method, offer counseling on alternative contraceptive methods, and initiate another method if desired 1.
From the FDA Drug Label
Therapy with norethindrone acetate tablets must be adapted to the specific indications and therapeutic response of the individual patient. Patients with a past history of recurrent episodes of abnormal uterine bleeding may benefit from planned menstrual cycling with norethindrone acetate tablets.
The treatment steps for increased frequency of menstruation, also known as abnormal uterine bleeding, may involve:
- Planned menstrual cycling with norethindrone acetate tablets to regulate the menstrual cycle
- Dosage adaptation to the specific indications and therapeutic response of the individual patient
- Initial daily dosage of 5 mg norethindrone acetate tablets, which may be increased by 2.5 mg per day every two weeks until 15 mg per day is reached 2 Note that the treatment should be adapted to the individual patient's response and indications.
From the Research
Treatment Steps for Increased Frequency of Menstruation
The treatment of increased frequency of menstruation, also known as menorrhagia or hypermenorrhea, involves a series of steps to manage the condition and improve the quality of life for affected women. The following are the key steps in the treatment process:
- Assessment and Diagnosis: The first step in treating increased frequency of menstruation is to assess and diagnose the condition. This involves a pelvic examination and, if necessary, a vaginal sonography to rule out any underlying uterine abnormalities, such as fibroids or endometrial polyps 3.
- Medical Treatment: Medical treatment is usually the first line of treatment for increased frequency of menstruation. This may include the use of non-steroidal anti-inflammatory drugs (NSAIDs), tranexamic acid, or hormonal contraceptives to reduce menstrual blood loss and regulate menstrual cycles 3, 4, 5.
- Hormonal Therapies: Hormonal therapies, such as the levonorgestrel-releasing intrauterine system (IUS), may also be used to treat increased frequency of menstruation. These therapies can help reduce menstrual blood loss and regulate menstrual cycles 3, 5.
- Surgical Interventions: In some cases, surgical interventions, such as endometrial ablation or hysterectomy, may be necessary to treat increased frequency of menstruation. However, these options are usually considered only after medical treatment has failed to provide adequate relief 3, 5.
- Lifestyle Modifications: Lifestyle modifications, such as dietary changes and stress management, may also be recommended to help manage increased frequency of menstruation and improve overall quality of life 6.
Treatment Options
The treatment options for increased frequency of menstruation include:
- Tranexamic Acid: Tranexamic acid is a medication that can help reduce menstrual blood loss by 26%-60% 5.
- NSAIDs: NSAIDs, such as ibuprofen or naproxen, can help reduce menstrual cramps and inflammation 4.
- Hormonal Contraceptives: Hormonal contraceptives, such as birth control pills or the IUS, can help regulate menstrual cycles and reduce menstrual blood loss 3, 6.
- Surgical Interventions: Surgical interventions, such as endometrial ablation or hysterectomy, may be necessary in some cases to treat increased frequency of menstruation 3, 5.