From the Guidelines
Menorrhagia treatment should prioritize non-hormonal options like tranexamic acid (1000-1300mg three times daily during menstruation) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400mg three times daily during menstruation), as these have been shown to be effective in reducing bleeding by affecting clotting mechanisms and prostaglandin production 1.
Treatment Options
When managing menorrhagia, it's essential to consider the patient's preferences, treatment goals, and medical history. The following treatment options may be considered:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can reduce bleeding by affecting prostaglandin production 1
- Antifibrinolytic agents like tranexamic acid, which can reduce bleeding by affecting clotting mechanisms 1
- Hormonal treatment, such as combined oral contraceptives or estrogen, may also be considered, but should be tailored to the patient's specific needs and medical history 1
Evaluation and Management
Patients with menorrhagia should be evaluated for underlying conditions like fibroids, polyps, or bleeding disorders, as treating these may resolve heavy bleeding 1. Treatment choice should consider the patient's age, desire for future fertility, symptom severity, and any contraindications to specific therapies. Lifestyle modifications like maintaining a healthy weight and managing stress may also help reduce menstrual bleeding in some cases.
Key Considerations
- Iron supplementation (325mg ferrous sulfate daily) is recommended for patients with anemia 1
- Surgical options, such as endometrial ablation or hysterectomy, may be considered for patients who do not respond to medical treatment 1
- Patient education and counseling on alternative contraceptive methods and treatment options are essential for effective management of menorrhagia 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