From the Guidelines
Acute menstrual suppression can be effectively managed with nonsteroidal anti-inflammatory drugs (NSAIDs) for 5-7 days, as recommended by the most recent guidelines. According to the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1, NSAIDs are a viable treatment option for spotting, light bleeding, or heavy/prolonged bleeding in users of various contraceptive methods, including Cu-IUD, LNG-IUD, implant, and injectable users.
Treatment Options
- For Cu-IUD users, NSAIDs can be used for 5-7 days to manage spotting, light bleeding, or heavy/prolonged bleeding 1.
- For LNG-IUD users, no interventions are identified, but NSAIDs can be considered for spotting, light bleeding, or heavy/prolonged bleeding 1.
- For implant users, NSAIDs can be used for 5-7 days to manage spotting or light bleeding, and additional options like hormonal treatment or antifibrinolytic agents can be considered for heavy or prolonged bleeding 1.
- For injectable (DMPA) users, a hormone-free interval for 3-4 consecutive days can be an option, but NSAIDs can also be used for spotting or light bleeding 1.
Important Considerations
- It is essential to explore patient goals and consider underlying health conditions that may be contributing to bleeding irregularities 1.
- Patients should be counseled on the potential effects of treatment options and the importance of follow-up care 1.
- The treatment options should be tailored to the patient's preferences, treatment goals, and medical history 1.
From the Research
Treatment Options for Acute Menstrual Suppression
The treatment options for acute menstrual suppression include:
- Combined hormonal contraceptives, such as combined oral contraceptive pills (COCs) or the contraceptive vaginal ring (CVR) 2, 3
- Levonorgestrel-releasing intrauterine system (LNG-IUS) 3, 4
- Tranexamic acid, an antifibrinolytic agent that reduces menstrual blood loss 5
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid or naproxen, which can help reduce menstrual bleeding and pain 6
- Other medical therapies, such as prostaglandin synthetase inhibitors or danazol 5, 2
Efficacy of Treatment Options
The efficacy of these treatment options varies:
- COCs have been shown to reduce menstrual blood loss by 40-60% and improve quality of life 2, 3
- LNG-IUS is more effective than COCs in reducing menstrual blood loss, with a reduction of 70-90% 3, 4
- Tranexamic acid reduces menstrual blood loss by 26-60% and is more effective than placebo or NSAIDs 5
- NSAIDs, such as mefenamic acid or naproxen, can reduce menstrual bleeding and pain, but the evidence is limited and of low certainty 6
Safety and Side Effects
The safety and side effects of these treatment options also vary:
- COCs are associated with an increased risk of venous thromboembolism, but the risk is low and the benefits of COCs may outweigh the risks 2
- LNG-IUS is generally well-tolerated, but may cause side effects such as breast tenderness or mood changes 4
- Tranexamic acid is generally well-tolerated, but may cause side effects such as nausea or diarrhea 5
- NSAIDs, such as mefenamic acid or naproxen, may cause side effects such as gastrointestinal upset or allergic reactions 6