From the Guidelines
Heavy uterine bleeding can be effectively managed with tranexamic acid, nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal treatments, with the goal of reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, provides guidance on the management of bleeding irregularities while using contraception, which can be applied to the treatment of menorrhagia. According to this study, treatment options for heavy or prolonged bleeding include NSAIDs for 5-7 days, hormonal treatment with low-dose combined oral contraceptives (COCs) or estrogen for 10-20 days, and antifibrinolytic agents like tranexamic acid for 5 days.
Treatment Options
- NSAIDs, such as ibuprofen, can decrease menstrual blood loss by 20-40% and also provide pain relief 1
- Tranexamic acid can reduce menstrual blood loss by up to 50% by preventing blood clot breakdown 1
- Hormonal treatments, such as low-dose COCs or estrogen, can help regulate menstrual cycles and reduce bleeding 1
- Antifibrinolytic agents, like tranexamic acid, can be used to reduce bleeding symptoms in patients with fibroids 1
Underlying Causes
It is essential to identify and address any underlying causes of heavy uterine bleeding, such as fibroids, polyps, or hormonal imbalances 1. If an underlying cause is found, treatment should be directed at addressing the underlying condition.
Quality of Life
The treatment of heavy uterine bleeding should prioritize improving quality of life, reducing morbidity, and minimizing mortality. Patients should be counseled on the available treatment options and involved in the decision-making process to ensure that their individual needs and preferences are taken into account 1.
From the FDA Drug Label
Progesterone capsules are used for the treatment of secondary amenorrhea (absence of menstrual periods in women who have previously had a menstrual period) due to a decrease in progesterone When you do not produce enough progesterone, menstrual irregularities can occur. If your healthcare provider has determined your body does not produce enough progesterone on its own, progesterone capsules may be prescribed to provide the progesterone you need
The treatment for menorrhagia (heavy uterine bleeding) is not directly addressed in the provided drug labels. However, progesterone capsules may be used to treat menstrual irregularities caused by a decrease in progesterone, which can include heavy uterine bleeding. The dosage for secondary amenorrhea is 400 mg at bedtime for 10 days 2.
- Key points:
- Progesterone capsules may be used to treat menstrual irregularities.
- The dosage for secondary amenorrhea is 400 mg at bedtime for 10 days.
- Menorrhagia treatment is not directly addressed in the provided drug labels.
From the Research
Treatment Options for Menorrhagia
- Medical therapy is usually considered a first-line treatment for idiopathic menorrhagia 3, 4
- Tranexamic acid has proven to be an effective treatment for heavy menstrual bleeding, reducing menstrual blood loss by 26%-60% and improving quality of life 3, 5, 6
- The recommended oral dosage of tranexamic acid is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 3
- Other medical treatment options include:
- Oral contraceptives, which may decrease menstrual flow by approximately 50% 4, 7
- Nonsteroidal anti-inflammatory drugs, which decrease bleeding by 30% to 50% 7
- Danazol, which has been used for the treatment of menorrhagia but has significant side effects 7
- GnRH analogues, which have been used for the treatment of menorrhagia but have significant side effects 7
- Levonorgestrel-releasing intrauterine system, which reduces menstrual blood loss more than tranexamic acid and is a long-term treatment option 3, 4
- Surgical interventions, such as endometrial ablation and hysterectomy, are also available for the treatment of menorrhagia 3, 4
- Emergency interventions for severe bleeding that causes hemodynamic instability include uterine tamponade, intravenous estrogen, dilation and curettage, and uterine artery embolization 4