Management of Increased Vaginal Bleeding

First-Line Treatment Options

The Centers for Disease Control and Prevention recommends nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for increased vaginal bleeding, particularly for heavy or prolonged menstrual bleeding, with a recommended short-term course of 5-7 days during days of bleeding 1, 2
NSAIDs have demonstrated significant reductions in menstrual blood loss in multiple studies and are recommended as first-line treatment for heavy vaginal bleeding 2
Multiple NSAIDs have shown effectiveness, including indomethacin, mefenamic acid, and flufenamic acid, which have all demonstrated statistically significant reductions in menstrual blood loss 1
Diclofenac sodium has also shown effectiveness in reducing heavy bleeding 2
The recommended duration of NSAID treatment is a short-term course of 5-7 days during days of bleeding 3
NSAIDs are particularly effective for copper IUD-associated heavy bleeding 2

For contraceptive implant users with irregular bleeding, low-dose combined oral contraceptives (COCs) or estrogen for short-term treatment (10-20 days) may be effective 4
The American Heart Association recommends the levonorgestrel-releasing intrauterine device (LNG-IUD) as the most effective approach for long-term management of heavy menstrual bleeding, resulting in 71% to 95% reduction in menstrual blood loss 5
Over time, bleeding generally decreases with LNG-IUD use, with many women experiencing only light menstrual bleeding or amenorrhea 3

Aspirin should be avoided as it has not shown effectiveness and may increase blood loss in women with lower baseline menstrual blood loss 1
Women with cardiovascular disease should avoid tranexamic acid and NSAIDs due to increased risk of thrombosis and MI 5