What birth control methods are effective in managing menorrhagia (heavy menstrual bleeding)?

From the Guidelines

Hormonal birth control methods, particularly the levonorgestrel-releasing intrauterine device (LNG-IUD), are the most effective options for managing heavy menstrual periods, reducing bleeding by 70-90% and even eliminating periods in some women after several months of use. According to the most recent guidelines, 1, the LNG-IUD is a highly effective treatment for heavy menstrual bleeding, and its use should be considered as a first-line option. The LNG-IUD works locally in the uterus, reducing menstrual blood loss by thinning the uterine lining and decreasing prostaglandins that cause heavy bleeding.

Some key points to consider when using hormonal birth control methods for heavy menstrual periods include:

• Combined hormonal contraceptives (containing estrogen and progestin) like birth control pills, the vaginal ring, or the patch can reduce menstrual bleeding by 40-50% 1
• Progestin-only options like the mini-pill, implant, or Depo-Provera injections can also help but may cause irregular spotting initially 1
• Before starting any method, it is essential to consult with a healthcare provider to rule out underlying conditions like fibroids or endometriosis that might require different treatment approaches 1
• The LNG-IUD is particularly effective for women with heavy menstrual bleeding, reducing bleeding by 70-90% and even eliminating periods in some women after several months of use 1

It is crucial to note that the management of bleeding irregularities while using contraception should be individualized, taking into account the patient's goals, medical history, and preferences 1. If bleeding irregularities occur, treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered, depending on the patient's specific situation and the type of contraceptive method being used 1.

From the Research

Birth Control Options for Managing Heavy Periods

• Combined hormonal contraceptives, such as the combined oral contraceptive pill (COCP), have been shown to be effective in reducing heavy menstrual bleeding 2.
• The COCP has been found to improve response to treatment and lower menstrual blood loss when compared to placebo 2.
• The levonorgestrel-releasing intrauterine system (LNG IUS) has been found to be more effective than COCP in reducing menstrual blood loss 2.
• Extended-cycle oral contraceptives, which provide a low-dose, combined active pill containing levonorgestrel and ethinyl estradiol, have been found to have a similar efficacy and adverse effect profile compared to other extended-regimen OCs 3.

Comparison of Birth Control Options

• A study comparing the COCP with the LNG IUS found that the LNG IUS was more effective in reducing menstrual blood loss, but it was not clear whether satisfaction with treatment or adverse effects varied according to which treatment was used 2.
• A comparison of the COCP with the contraceptive vaginal ring (CVR) found that there was no evidence of a benefit for one treatment compared to the other for response to treatment, menstrual blood loss, or participant satisfaction with treatment 2.
• A review of the literature on extended-cycle OCs found that they have a similar efficacy and adverse effect profile compared to other extended-regimen OCs, and that the unscheduled bleeding profile improves with the increase in the duration of use 3.

Effectiveness of Birth Control for Heavy Periods

• A study found that the COCP improved hemoglobin and hematocrit levels in women with heavy menstrual bleeding, and that the addition of a gonadotropin-releasing hormone analog to the COCP resulted in better control of vaginal bleeding 4.
• A review of the literature on the use of oral contraceptive pills for heavy menstrual bleeding found that the evidence was not sufficient to adequately assess the effectiveness of OCP due to the paucity of data 5.
• A study comparing the levonorgestrel-releasing intrauterine system with endometrial ablation for heavy menstrual bleeding found that both treatments led to a large decrease in menstrual blood loss, but that endometrial ablation was more effective in reducing menstrual blood loss 6.