Treatment Options for Heavy Menstrual Bleeding

First-Line Treatment Options

The American College of Obstetricians and Gynecologists recommends the levonorgestrel-releasing intrauterine device (LNG-IUD) as the most effective first-line treatment for heavy menstrual bleeding, reducing menstrual blood loss by 71-95% while providing contraception 1, 2
Naproxen and other NSAIDs have been shown to significantly reduce mean total menstrual blood loss, and are recommended for short-term treatment (5-7 days) during days of bleeding 3, 2

Cyclic oral progestins reduce bleeding by approximately 87%, though may result in irregular bleeding patterns, according to the American College of Obstetricians and Gynecologists 1
Combined hormonal contraceptives are effective for reducing menstrual blood loss when hormonal options are appropriate, as recommended by the American College of Obstetricians and Gynecologists 2
Antifibrinolytic agents, such as tranexamic acid, reduce bleeding symptoms in patients with fibroids or other causes of heavy bleeding, as reported by the Journal of the American College of Radiology 4

Initial assessment should include evaluating severity of bleeding, ruling out pregnancy in reproductive-age women, checking for signs of hemodynamic instability, and evaluating for underlying gynecological problems, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 3
First-line treatment options include LNG-IUD for women desiring contraception or long-term solution, NSAIDs for short-term symptom management, and tranexamic acid for non-hormonal option, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 3

Enhanced counseling about expected bleeding patterns improves treatment adherence, as reported by the MMWR Recommendations and Reports 3
Up to 20% of women with heavy menstrual bleeding may have an underlying inherited bleeding disorder, according to the American College of Obstetricians and Gynecologists 2
Hormone-free intervals are not recommended more than once per month for CHC users on extended or continuous regimens as contraceptive effectiveness might be reduced, as reported by the MMWR Recommendations and Reports 5