Can I use Pepcid (famotidine) for reflux and Claritin (loratadine) for allergies to treat menstrual cramps or heavy menstrual bleeding in a reproductive‑age woman?

Pepcid and Claritin Do Not Treat Menstrual Cramps or Heavy Bleeding

Neither Pepcid (famotidine) nor Claritin (loratadine) have any role in treating menstrual cramps or heavy menstrual bleeding—these medications treat reflux and allergies respectively and will not address your menstrual symptoms. For menstrual cramps and heavy bleeding, you need entirely different medications.

Evidence-Based Treatments for Heavy Menstrual Bleeding

First-Line Treatment: NSAIDs

• NSAIDs are the recommended first-line pharmacologic treatment for heavy menstrual bleeding, taken for 5-7 days during menstruation only. 1
• Effective options include mefenamic acid, naproxen, indomethacin, and diclofenac sodium—these reduce menstrual blood loss by 20-60% and also treat menstrual cramps. 1, 2
• Avoid aspirin, as it does not reduce bleeding and may actually increase blood loss. 1
• NSAIDs must be avoided if you have cardiovascular disease due to increased risk of myocardial infarction and thrombosis. 1

Most Effective Treatment: Levonorgestrel IUD

• The levonorgestrel-releasing intrauterine device (LNG-IUD) is the most effective medical treatment, reducing menstrual blood loss by 71-95%. 1, 3
• Over time, many women experience only light menstrual bleeding or complete absence of periods with the LNG-IUD. 1
• This option provides both contraception and treatment of heavy bleeding simultaneously. 4

Alternative Non-Hormonal Option: Tranexamic Acid

• Tranexamic acid reduces menstrual blood loss by approximately 34-60% when taken for 4-5 days beginning on the first day of menses. 1, 2
• This is absolutely contraindicated if you have active blood clots, history of thrombosis, or cardiovascular disease. 1
• Tranexamic acid is less effective than the LNG-IUD but serves as an effective non-hormonal alternative when hormonal therapy is unsuitable. 1

Critical Initial Assessment Required

Before starting any treatment, you must:

• Rule out pregnancy with a beta-hCG test—this is mandatory in all reproductive-age women with abnormal bleeding. 1, 3
• Assess for structural causes including fibroids, polyps, adenomyosis, or endometrial pathology through pelvic examination and ultrasound. 1, 2
• Evaluate for bleeding disorders if clinically indicated, as up to 20% of women with heavy menstrual bleeding may have an underlying inherited bleeding disorder. 1, 5

Treatment Algorithm

Step 1: Start with NSAIDs (mefenamic acid 500 mg three times daily or naproxen) for 5-7 days during menstruation if you have no cardiovascular contraindications. 1, 6

Step 2: If NSAIDs are insufficient or you desire contraception, consider the LNG-IUD as it is significantly more effective (71-95% reduction versus 20-60% with NSAIDs). 1, 7

Step 3: If you cannot use hormonal methods, tranexamic acid 3.9-4 g per day for 4-5 days starting from the first day of menstruation is the non-hormonal alternative. 4

Step 4: If medical treatment fails after adequate trial, consider endometrial ablation or, as definitive treatment, hysterectomy. 3

Common Pitfall to Avoid

Do not use cyclic oral progestogen alone (progesterone-only pills taken part of the month) as this does not significantly reduce menstrual bleeding in women who ovulate normally. 2 Combined hormonal contraceptives (containing both estrogen and progestin) are effective, but the LNG-IUD remains superior. 1, 4