What medication can stop increased vaginal bleeding?

Medications to Stop Increased Vaginal Bleeding

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for increased vaginal bleeding, particularly for heavy or prolonged menstrual bleeding, with a recommended short-term course of 5-7 days during days of bleeding. 1

First-Line Treatment Options

NSAIDs

• NSAIDs have demonstrated significant reductions in menstrual blood loss in multiple studies and are recommended as first-line treatment for heavy vaginal bleeding 1
• Multiple NSAIDs have shown effectiveness:
  • Indomethacin, mefenamic acid, and flufenamic acid have all demonstrated statistically significant reductions in menstrual blood loss 1
  • Diclofenac sodium has also shown effectiveness in reducing heavy bleeding 1
• Recommended duration: Short-term treatment for 5-7 days during days of bleeding 1
• NSAIDs are particularly effective for copper IUD-associated heavy bleeding 1

Tranexamic Acid

• Tranexamic acid significantly reduces mean blood loss during treatment compared with placebo 1
• One study showed tranexamic acid reduced menstrual blood loss by 26%-60% 2
• Recommended oral dosage: 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 2
• Important safety consideration: Tranexamic acid is contraindicated in women with active thromboembolic disease or with a history or intrinsic risk for thrombosis or thromboembolism 1, 2

Second-Line Treatment Options

Hormonal Treatments

For Contraceptive Implant Users with Irregular Bleeding

• Low-dose combined oral contraceptives (COCs) or estrogen for short-term treatment (10-20 days) 1
• COCs containing ethinyl estradiol 30 μg and norgestrel 0.3 mg have shown effectiveness comparable to tranexamic acid in reducing heavy menstrual bleeding 3

For Non-Functional Bleeding

• Norethindrone acetate 2.5 to 10 mg daily for 5 to 10 days can produce secretory transformation of the endometrium and control bleeding 4
• For endometriosis-related bleeding, norethindrone acetate starting at 5 mg daily, increased by 2.5 mg every two weeks until reaching 15 mg daily 4

Levonorgestrel-Releasing Intrauterine Device (LNG-IUD)

• Most effective approach for long-term management of heavy menstrual bleeding, resulting in 71% to 95% reduction in menstrual blood loss 1
• Over time, bleeding generally decreases with LNG-IUD use, with many women experiencing only light menstrual bleeding or amenorrhea 1

Treatment Algorithm

1. Rule out underlying gynecological problems before treatment:

   • Check for IUD displacement, STDs, pregnancy, or pathologic uterine conditions (polyps, fibroids) 1
   • Treat any identified underlying conditions or refer for care

2. First-line treatment for acute heavy bleeding without underlying pathology:

   • NSAIDs for 5-7 days during days of bleeding 1
   • Options include mefenamic acid, indomethacin, or diclofenac sodium 1

3. If NSAIDs are ineffective or contraindicated:

   • Consider tranexamic acid 3.9-4 g/day for 4-5 days if no contraindications exist 2
   • For women with fibroids, combined oral contraceptives may be more effective than tranexamic acid 3

4. For recurrent or persistent bleeding:

   • Consider hormonal options: norethindrone acetate, combined oral contraceptives, or LNG-IUD 4, 1
   • For women with endometriosis-related bleeding, consider norethindrone acetate in escalating doses 4

Important Considerations and Caveats

• Aspirin should be avoided as it has not shown effectiveness and may increase blood loss in women with lower baseline menstrual blood loss 1
• Tranexamic acid is contraindicated in women with active or history of thromboembolic disease 2
• For women using copper IUDs who experience heavy bleeding, NSAIDs are particularly effective 1
• Progestin withdrawal bleeding usually occurs within three to seven days after discontinuing norethindrone acetate therapy 4
• Women with cardiovascular disease should avoid tranexamic acid and NSAIDs due to increased risk of thrombosis and MI 1
• Patients with leiomyomas (fibroids) may benefit more significantly from combined oral contraceptives than from tranexamic acid 3