Ascorbic Acid Has No Established Role in Managing Abnormal Uterine Bleeding
Ascorbic acid (Vitamin C) is not recommended or mentioned in current evidence-based guidelines for the management of abnormal uterine bleeding, and there is no high-quality evidence supporting its use for this indication.
Evidence-Based Treatment Options Instead of Ascorbic Acid
The comprehensive guidelines from the American College of Obstetricians and Gynecologists and American College of Radiology do not include ascorbic acid in their treatment algorithms for abnormal uterine bleeding 1, 2. The established first-line medical treatments are:
Primary Medical Management
- Levonorgestrel-releasing intrauterine device (LNG-IUD) is the most effective first-line medical treatment, reducing menstrual blood loss by 71-95% with efficacy comparable to endometrial ablation 2
- Combined hormonal contraceptives are effective for ovulatory dysfunction bleeding and can be combined with NSAIDs to further reduce bleeding volume 2
- Tranexamic acid is a viable option for heavy menstrual bleeding with high efficacy 3, 4
- Oral progestins administered for 21 days per month effectively reduce menstrual blood loss in women with cyclic heavy bleeding 2
Acute Bleeding Management
For acute abnormal uterine bleeding with a normal uterus, the evidence-based options include 3:
- Parenteral estrogen
- Multidose combined oral contraceptive regimen
- Multidose progestin-only regimen
- Tranexamic acid
Why Ascorbic Acid Is Not Recommended
None of the current major guidelines (American College of Radiology 2020, American College of Obstetricians and Gynecologists, American Academy of Family Physicians) mention ascorbic acid as a treatment modality for abnormal uterine bleeding 5, 1, 2. The PALM-COEIN classification system, which categorizes all recognized causes of abnormal uterine bleeding, does not include vitamin C deficiency as an etiology 1, 2.
Critical Diagnostic Steps Before Any Treatment
Before initiating any treatment, the following must be completed 1:
- Pregnancy testing in all reproductive-age women (β-hCG)
- Combined transabdominal and transvaginal ultrasound with Doppler as first-line imaging
- Thyroid-stimulating hormone and prolactin levels
- Complete blood count with platelets to assess for anemia and coagulopathy 4
Important Clinical Caveats
In patients with cardiovascular disease, avoid NSAIDs and tranexamic acid due to MI and thrombosis risk; the levonorgestrel-releasing IUD becomes the preferred option 1, 2.
If bleeding persists despite initial medical therapy, further investigation with hysteroscopy is indicated to diagnose focal lesions potentially missed by endometrial sampling 2.
Endometrial biopsy alone should not be used to rule out focal lesions due to variable sensitivity; saline infusion sonohysterography has superior sensitivity (96-100%) and negative predictive value (94-100%) for uterine and endometrial pathology 1, 2.