From the Guidelines
Menorrhagia should be treated with tranexamic acid (1000mg three times daily during bleeding) as the first line of treatment, as it has been shown to be effective in reducing heavy menstrual bleeding by promoting blood clotting 1. When treating menorrhagia, it is essential to consider the underlying cause and severity of the condition.
Treatment Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg every 6-8 hours during bleeding) or naproxen (500mg twice daily) can reduce blood loss by 20-50% by decreasing prostaglandin production 1.
- Hormonal treatments, including combined oral contraceptives taken cyclically or continuously, or the levonorgestrel intrauterine system (Mirena), can reduce bleeding by up to 90% 1.
- For iron deficiency from blood loss, supplement with ferrous sulfate 325mg daily.
Non-Pharmacological Options
- Endometrial ablation to destroy the uterine lining
- Hysterectomy for severe cases unresponsive to other treatments
Lifestyle Modifications
- Maintaining a healthy weight
- Managing stress to help regulate hormones It is crucial to seek medical attention if bleeding soaks through a pad/tampon hourly for several consecutive hours, as this could indicate a more serious condition requiring immediate intervention 1.
From the Research
Treatment Options for Menorrhagia
The treatment of menorrhagia can be medical or surgical, depending on the underlying cause and the patient's desire for future fertility 2, 3, 4, 5, 6.
- Medical treatment options include:
- Pharmaceutical agents such as levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin, and non-steroidal anti-inflammatory drugs 2, 3, 4, 5
- Tranexamic acid has been shown to be effective in reducing menstrual blood loss by 34-59% 3
- Levonorgestrel intra-uterine device has been shown to reduce menstrual blood loss by 96% after 12 months 3
- Surgical treatment options include:
- Endometrial curettage for women who desire pregnancy in the future 2
- Endometrial ablation or hysterectomy for women who no longer intend to get pregnant 2, 5, 6
- Hysteroscopic polypectomy for menorrhagia associated with endometrial polyps 2
- Hysteroscopic myomectomy for menorrhagia related to submucosal myomas 2
- Laparoscopic or abdominal myomectomy for women who still want to be pregnant, and myomectomy or uterine arteries embolization for women who no longer desire pregnancy 2
Diagnosis and Evaluation
The diagnosis and evaluation of menorrhagia involve a thorough medical history, physical examination, and laboratory tests 4, 5, 6.
- A pelvic examination and vaginal sonography should be performed to rule out any uterine abnormalities 4
- Endometrial biopsy is effective for diagnosing precancerous lesions and adenocarcinoma, but not for intracavitary lesions 6
- Saline infusion sonohysteroscopy can detect intracavitary abnormalities such as endometrial polyps or uterine leiomyoma 6
Quality of Life and Treatment Outcomes
The treatment of menorrhagia can result in substantial improvement in quality of life 4, 6.