From the Guidelines
Menorrhagia treatment should prioritize nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or tranexamic acid as first-line medical treatments, considering the patient's preferences, treatment goals, and medical history, as recommended by the most recent guidelines 1. When managing menorrhagia, it is essential to address the underlying cause while providing treatment for heavy menstrual bleeding. The treatment options may vary depending on the patient's contraceptive method, such as Cu-IUD, LNG-IUD, implant, or injectable users, as outlined in the guidelines 1.
Key Treatment Options
- NSAIDs, such as ibuprofen (600-800mg three times daily during menses) or mefenamic acid, for 5-7 days, are recommended for spotting, light bleeding, or heavy/prolonged bleeding in Cu-IUD, LNG-IUD, implant, and injectable users 1.
- Tranexamic acid (1000-1300mg three times daily during bleeding) is also an option for heavy or prolonged bleeding, particularly for implant users 1.
- Hormonal treatments, such as combined oral contraceptives or the levonorgestrel intrauterine system (Mirena), may be considered for women who desire to continue their contraceptive method while managing bleeding irregularities 1.
Additional Considerations
- Iron supplementation (325mg ferrous sulfate 1-3 times daily) may be necessary to treat or prevent anemia, especially in women with heavy menstrual bleeding 1.
- Surgical options, such as endometrial ablation or hysterectomy, may be considered for women who do not respond to medical management or have severe symptoms 1.
- It is crucial to explore patient goals, including continued method use or method discontinuation, and provide reassurance and counseling on alternative contraceptive methods if needed 1.
From the FDA Drug Label
In cases of breakthrough bleeding, as in all cases of irregular bleeding per vaginum, nonfunctional causes should be borne in mind and adequate diagnostic measures undertaken. The treatment for menorrhagia may involve the use of medroxyprogesterone acetate (PO), as it can help regulate menstrual bleeding.
- Breakthrough bleeding and irregular bleeding can be managed with this medication. However, it is essential to rule out malignancy and other underlying causes of abnormal vaginal bleeding before initiating treatment 2.
From the Research
Treatment Options for Menorrhagia
- Pharmaceutical agents are the first line of treatment for women with idiopathic menorrhagia, including levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin, and non-steroidal anti-inflammatory drugs 3
- Surgical options, such as endometrial curettage, endometrial ablation, or hysterectomy, may be considered for women who do not respond to pharmaceutical treatment or who no longer desire pregnancy 3
- Tranexamic acid has been shown to be an effective treatment for heavy menstrual bleeding, reducing menstrual blood loss by 26%-60% 4, 5
- Non-steroidal anti-inflammatory drugs (NSAIDs) also reduce menstrual blood loss, but are less effective than tranexamic acid, danazol, or the levonorgestrel-releasing intrauterine system (LNG IUS) 6
Specific Treatment Approaches
- For women with menorrhagia associated with endometrial polyps, hysteroscopic polypectomy may be effective, with or without the use of a levonorgestrel intra-uterine device or endometrial ablation 3
- For women with menorrhagia related to submucosal myomas, hysteroscopic myomectomy may be considered as a first-line treatment or after failure of pharmaceutical management 3
- For women with interstitial myomas, medical management may be the first line of treatment, followed by laparoscopic or abdominal myomectomy for women who still want to be pregnant, and by myomectomy or uterine arteries embolization for women who no longer desire pregnancy 3
Considerations for Treatment
- The choice of treatment should be based on the individual woman's needs and preferences, taking into account her desire for future pregnancy and her overall health status 3, 7
- A rigorous assessment of the patient, including a pelvic examination and vaginal sonography, is necessary to determine the underlying cause of menorrhagia and to guide treatment decisions 7