From the Guidelines
Menometrorrhagia should be managed by exploring patient goals and considering treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents, depending on the patient's preferences, treatment goals, and medical history, as recommended by the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1.
Treatment Options
The treatment of menometrorrhagia typically involves a combination of medical and hormonal therapies.
- For patients using a copper intrauterine device (Cu-IUD), treatment options may include NSAIDs for 5-7 days to reduce bleeding and pain 1.
- For patients using a levonorgestrel intrauterine device (LNG-IUD), no interventions may be necessary, but NSAIDs or hormonal treatment may be considered if bleeding persists 1.
- For patients using an implant, NSAIDs or hormonal treatment may be used to reduce bleeding, and antifibrinolytic agents such as tranexamic acid may also be considered 1.
Investigation of Underlying Cause
It is essential to investigate the underlying cause of menometrorrhagia, as it could result from hormonal imbalances, uterine fibroids, polyps, endometriosis, or other conditions 1.
Surgical Options
For severe cases unresponsive to medication, surgical options like endometrial ablation or hysterectomy might be considered, especially if the patient has concomitant significant intracavitary lesions 1.
Patient Education
Patients should be educated on the importance of seeking medical attention if they experience severe bleeding, bleeding lasting more than 7 days, or symptoms of anemia like fatigue or dizziness. The 2024 U.S. Selected Practice Recommendations for Contraceptive Use provide the most recent and highest-quality guidance on the management of menometrorrhagia, and their recommendations should be prioritized in clinical practice 1.
From the Research
Definition and Prevalence of Menometrorrhagia
- Menometrorrhagia is defined as excessive and prolonged uterine bleeding occurring at irregular and/or frequent intervals 2
- It occurs in up to 24% of women aged 40-50 years 2
- The prevalence of abnormal uterine bleeding (AUB) is estimated at 11-13% in the general population and increases with age, reaching 24% in those aged 36-40 years 3
Causes and Diagnosis of Menometrorrhagia
- There are a wide range of causes of menometrorrhagia, including myomas, adenomyosis, and dysfunctional endometrium 2
- Primary diagnosis needs to exclude pregnancy and cancer, whereas secondary investigations (including ultrasound with instillation of saline solution, hysteroscopy and biopsy, and magnetic resonance imaging) can assist in accurately diagnosing the underlying cause of menometrorrhagia 2
- Pelvic ultrasound, both abdominal (suprapubic) and transvaginal, is recommended as a first-line procedure for the etiological diagnosis of AUB 3
Treatment Options for Menometrorrhagia
- The first line of treatment recommended for women with idiopathic menorrhagia is pharmaceutical agents, i.e. levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin and non-sterodial anti-inflammatory drugs 4, 3
- Medical treatments include combined oral contraception, progestins and levonorgestrel-releasing Intrauterine System 5
- Surgical options include endometrial ablation, hysterectomy, and uterine artery embolisation 4, 3, 5
- Selective Progesterone Receptor Modulators (SPRMs) have been shown to induce amenorrhea whilst maintaining endogenous estrogen secretion and may control uterine bleeding via a direct effect on endometrial blood vessels 5