What is the diagnosis and treatment for polymenorrhea (frequent menstrual bleeding)?

From the Guidelines

Polymenorrhea should be managed by evaluating the underlying cause and considering treatment options such as hormonal contraceptives, non-steroidal anti-inflammatory drugs, and lifestyle modifications, as recommended by the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1.

Evaluation and Treatment

When evaluating polymenorrhea, it is essential to consider the patient's goals, including continued method use or method discontinuation, and to explore any underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions (e.g., polyps or fibroids) 1.

Treatment Options

Treatment options for polymenorrhea may include:

• Hormonal contraceptives, such as combined oral contraceptive pills, to regulate cycles
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage associated pain and heavy bleeding
• Lifestyle modifications, including maintaining a healthy weight, regular exercise, and stress management techniques, to improve symptoms
• Iron supplementation, such as ferrous sulfate, if anemia develops due to frequent bleeding

Specific Recommendations

According to the 2024 U.S. Selected Practice Recommendations for Contraceptive Use, for patients using contraceptive methods, the following treatment options may be considered:

• For Cu-IUD users, NSAIDs, 5–7 days, may be used for spotting or light bleeding or for heavy or prolonged bleeding 1
• For LNG-IUD users, no interventions are identified, but for spotting or light bleeding or heavy/prolonged bleeding, treatment may be repeated as needed 1
• For implant users, NSAIDs, 5–7 days, may be used for spotting or light bleeding, and hormonal treatment, 10–20 days, or antifibrinolytic agents, 5 days, may be used for heavy or prolonged bleeding 1

Important Considerations

Patients should seek immediate medical attention if experiencing severe pain, very heavy bleeding, or signs of anemia, such as extreme fatigue or dizziness, as polymenorrhea can sometimes indicate more serious underlying conditions requiring prompt treatment 1.

From the FDA Drug Label

Breakthrough bleeding and spotting are sometimes encountered in patients on oral contraceptives, especially during the first three months of use Non-hormonal causes should be considered and adequate diagnostic measures taken to rule out malignancy or pregnancy in the event of breakthrough bleeding, as in the case of any abnormal vaginal bleeding. If pathology has been excluded, time or a change to another formulation may solve the problem. In the event of amenorrhea, pregnancy should be ruled out Some women may encounter post-pill amenorrhea or oligomenorrhea, especially when such a condition was pre-existent.

Polymenorrhea is not directly addressed in the provided drug label. However, bleeding irregularities are discussed, including breakthrough bleeding and spotting.

• The label mentions that non-hormonal causes should be considered in the event of abnormal vaginal bleeding.
• It also states that pregnancy should be ruled out in the event of amenorrhea.
• Additionally, some women may experience post-pill amenorrhea or oligomenorrhea, especially if such a condition was pre-existent. However, polymenorrhea, which is characterized by frequent menstrual bleeding, is not explicitly mentioned in the label 2.

From the Research

Definition and Prevalence of Polymenorrhea

• Polymenorrhea is not directly defined in the provided studies, but it can be inferred that it refers to frequent or abnormal menstrual bleeding.
• Studies on dysmenorrhea, such as 3, suggest that menstrual disorders are common among women of reproductive age.

Relationship between Polymenorrhea and Dysmenorrhea

• Dysmenorrhea, or painful menstruation, is a related condition that may be associated with polymenorrhea.
• According to 4, primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause.
• The studies suggest that dysmenorrhea can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies, which may also be effective for polymenorrhea.

Treatment Options for Polymenorrhea

• NSAIDs, such as those used to treat dysmenorrhea, may be effective in reducing menstrual bleeding, as suggested by 5.
• Hormonal therapies, such as contraceptive hormonal therapy, may also be effective in treating polymenorrhea, as mentioned in 3 and 4.
• Other treatment options, such as tranexamic acid and the levonorgestrel-releasing intrauterine system (LNG IUS), may be more effective than NSAIDs in reducing menstrual bleeding, as shown in 5.

Diagnosis and Evaluation of Polymenorrhea

• A menstrual history and pregnancy test should be included in the initial workup for women with suspected polymenorrhea, as recommended in 3.
• Further evaluation, including pelvic examination and ultrasonography, may be necessary to rule out underlying causes of abnormal menstrual bleeding, as suggested in 3.