How to stop heavy menstrual bleeding after starting birth control?

From the Guidelines

If you're experiencing heavy menstrual bleeding after starting birth control, contact your healthcare provider promptly to discuss treatment options, which may include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or tranexamic acid, as recommended by the most recent guidelines 1. To manage heavy menstrual bleeding after starting birth control, it's essential to consider the patient's goals and preferences, as well as their medical history. The patient may want to continue using their current birth control method, in which case the provider can offer reassurance and advise them to contact their provider if they experience any bleeding irregularities or other side effects. Some key points to consider when managing heavy menstrual bleeding after starting birth control include:

• Exploring patient goals, including continued method use or method discontinuation
• Considering an underlying health condition, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions
• Discussing treatment options, such as hormonal treatment, antifibrinolytic agents, or NSAIDs, depending on the patient's preferences and medical history
• Advising the patient to contact their provider if they experience any bleeding irregularities or other side effects The most recent guidelines recommend the following treatment options for heavy menstrual bleeding:
• NSAIDs, such as ibuprofen, for 5-7 days
• Tranexamic acid, for 5 days
• Hormonal treatment, such as low-dose combined oral contraceptives or estrogen, for 10-20 days
• Antifibrinolytic agents, such as tranexamic acid, for 5 days It's essential to note that these treatment options may have varying effects on bleeding irregularities, and the patient's provider should discuss the potential benefits and risks of each option with them. In terms of specific treatment regimens, the guidelines recommend the following:
• For Cu-IUD users, NSAIDs or hormonal treatment may be considered for spotting or light bleeding, while NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered for heavy or prolonged bleeding
• For LNG-IUD users, no interventions are identified for spotting or light bleeding, while NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered for heavy or prolonged bleeding
• For implant users, NSAIDs may be considered for spotting or light bleeding, while NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered for heavy or prolonged bleeding
• For injectable (DMPA) users, a hormone-free interval for 3-4 consecutive days may be considered
• For CHC users (extended or continuous regimen), a hormone-free interval for 3-4 consecutive days may be considered, but not recommended during the first 21 days of extended or continuous CHC use. Overall, the management of heavy menstrual bleeding after starting birth control requires a patient-centered approach, taking into account the patient's goals, preferences, and medical history, as well as the most recent guidelines and evidence-based treatment options 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Stopping Heavy Menstrual Bleeding after Starting Birth Control

To address the issue of heavy menstrual bleeding after starting birth control, several options can be considered:

• Hormonal adjustments: Changing the type or dosage of birth control pills may help alleviate heavy menstrual bleeding 2.
• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as mefenamic acid, ibuprofen, or naproxen can be used to reduce menstrual blood loss and pain 2, 3.
• Tranexamic acid: This antifibrinolytic agent can be used to reduce menstrual blood loss, especially in women with heavy menstrual bleeding 4, 3.
• Levonorgestrel-releasing intrauterine system (LNG-IUS): The LNG-IUS has been shown to significantly reduce menstrual blood loss and is a highly effective treatment for heavy menstrual bleeding 4, 5.

Treatment Options

The following treatment options can be considered for heavy menstrual bleeding:

• Vitamin B1: May reduce menstrual blood loss and the number of bleeding days 3.
• Mefenamic acid: May reduce menstrual blood loss and pain 3.
• Tolfenamic acid: May prevent heavy menstrual bleeding and reduce pain 3.
• Ulipristal acetate: May not be effective in reducing menstrual blood loss or pain in women using the LNG-IUS 3.

Prevention of Heavy Menstrual Bleeding

To prevent heavy menstrual bleeding, the following options can be considered:

• Tolfenamic acid: May prevent heavy menstrual bleeding in women using the copper IUD 3.
• Ibuprofen: May not be effective in preventing heavy menstrual bleeding or reducing pain 3.
• Aspirin: May not prevent heavy menstrual bleeding compared to paracetamol 3.