What medication can help with heavy menstrual bleeding?

Medications for Heavy Menstrual Bleeding

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for heavy menstrual bleeding, taken for 5-7 days during menstruation. 1 For women with more severe bleeding or those who don't respond to NSAIDs, additional medication options are available.

First-Line Treatment Options

NSAIDs

• Mechanism: Reduce prostaglandin activity in menstrual fluid, decreasing uterine contractions and blood flow
• Dosage: Short-term treatment (5-7 days) during days of bleeding
• Evidence: Multiple studies show NSAIDs can significantly reduce menstrual blood loss 1
• Example: Ibuprofen has been shown to reduce elevated levels of prostaglandin activity in menstrual fluid and reduce both resting and active intrauterine pressure 2

Second-Line Treatment Options

Tranexamic Acid

• Mechanism: Antifibrinolytic that prevents breakdown of blood clots
• Dosage: 3.9-4g/day for 4-5 days starting from first day of menstrual cycle
• Efficacy: Reduces menstrual blood loss by 26-60% 3
• Caution: Contraindicated in women with active thromboembolic disease or history/risk of thrombosis 1, 3

Combined Hormonal Contraceptives

• Mechanism: Thin the endometrium and regulate menstrual cycles
• Efficacy: Can increase treatment success from 3% to 77% compared to placebo 4
• Best for: Women who also desire contraception

Levonorgestrel Intrauterine System (LNG-IUS)

• Efficacy: More effective than combined oral contraceptives in reducing menstrual blood loss 4
• Reduction: 71-95% reduction in menstrual blood loss 5

Treatment Algorithm

1. Initial Assessment:

   • Rule out underlying gynecological problems (STIs, pregnancy, fibroids, polyps)
   • Classify bleeding using PALM-COEIN system 5
   • Complete blood count to assess for anemia

2. First-Line Treatment:

   • NSAIDs for 5-7 days during menstruation
   • Monitor response for 2-3 cycles

3. If inadequate response:

   • For women needing contraception: Consider combined hormonal contraceptives or LNG-IUS
   • For women not needing contraception: Consider tranexamic acid
   • For women with contraindications to hormonal therapy: Tranexamic acid

4. If medical management fails after 3-6 months:

   • Consider referral for endometrial ablation or hysterectomy 5

Common Pitfalls to Avoid

• Failure to rule out underlying conditions: Always consider structural causes like fibroids or polyps before initiating treatment
• Inadequate dosing or duration: NSAIDs must be taken for the full 5-7 days during bleeding for maximum effect
• Overlooking contraindications: Tranexamic acid should not be used in women with thromboembolic disease or risk factors
• Not providing adequate counseling: Women should understand that bleeding irregularities with Cu-IUD use are common in the first 3-6 months 1
• Premature abandonment of therapy: Allow adequate trial period (3-6 months) before considering treatment failure

By following this evidence-based approach, most women with heavy menstrual bleeding can achieve significant improvement in symptoms and quality of life with medical management.