What is the initial treatment for a patient presenting with menorrhagia (heavy menstrual bleeding) lasting 1 week in an urgent care setting?

Treatment of Heavy Menstrual Bleeding in Urgent Care Setting

For patients presenting with heavy menstrual bleeding (menorrhagia) lasting 1 week in an urgent care setting, NSAIDs for short-term treatment (5-7 days) are the recommended first-line intervention. 1

Initial Assessment and Management

• Rule out serious underlying causes:

  • Check for signs of hemodynamic instability (tachycardia, hypotension)
  • Assess for anemia (pallor, fatigue)
  • Consider pregnancy test to rule out pregnancy-related bleeding
  • Evaluate for possible underlying gynecological problems (STIs, fibroids, polyps)

• First-line treatment options:

  • NSAIDs for 5-7 days during days of bleeding 1
    • Reduces menstrual blood loss by 20-60% 2
    • Options include mefenamic acid or naproxen
    • Mechanism: Reduces prostaglandin levels which are elevated in women with excessive menstrual bleeding 2

• If heavy bleeding persists and underlying gynecologic problem is not found:

  • Consider adding hormonal treatment if medically eligible:
    • Low-dose combined oral contraceptives for short-term treatment (10-20 days) 1
    • Estrogen for short-term treatment (10-20 days) 1

Second-line Options

• Tranexamic acid:
  • More effective than NSAIDs in reducing menstrual blood loss 2
  • Antifibrinolytic agent that can reduce blood loss by 20-60% 3
  • Consider when NSAIDs are contraindicated or ineffective

Important Considerations

• Heavy menstrual bleeding affects approximately 30% of women at some point in their lives 4
• Objective definition: blood loss ≥80 ml per menstruation 4
• In approximately 50% of cases, no underlying pathology is found 4

Follow-up Recommendations

• Advise patient to follow up with primary care or gynecology if:
  • Bleeding does not improve within 5-7 days of treatment
  • Symptoms recur after treatment
  • Anemia is present and requires further management

Pitfalls to Avoid

• Don't miss underlying pathology: Always consider potential underlying causes such as fibroids, polyps, or endometrial hyperplasia, especially in women over 40 years 3
• Don't delay treatment: Prompt intervention can prevent complications such as severe anemia
• Don't forget contraindications to NSAIDs: Including peptic ulcer disease, renal impairment, or aspirin-sensitive asthma
• Don't overlook the need for iron supplementation: Consider in patients with signs of anemia

Heavy menstrual bleeding is an important healthcare problem that requires prompt and effective management in the urgent care setting. While NSAIDs are the first-line treatment for short-term management, patients should be referred for appropriate follow-up care to address any underlying conditions and for long-term management if needed.