Approach to Prolonged Menstruation

Initial Assessment and Treatment

The American College of Obstetricians and Gynecologists recommends ruling out pregnancy in all reproductive-age women presenting with abnormal bleeding 1
The Centers for Disease Control and Prevention suggests assessing for structural pathology, including fibroids, polyps, adenomyosis, endometrial pathology, or malignancy through pelvic examination and vaginal sonography 1
The National Institutes of Health recommends screening for coagulopathies if clinically indicated, as up to 20% of women with heavy menstrual bleeding may have an underlying inherited bleeding disorder 1
The Centers for Disease Control and Prevention advises evaluating for IUD displacement, STDs, or medication interactions in women using contraceptive devices or hormonal methods 2, 3

The American College of Obstetricians and Gynecologists recommends NSAIDs as the first-line treatment for prolonged menstrual bleeding, prescribed for 5-7 days during menstruation only 1
The American Heart Association suggests avoiding aspirin, as it does not reduce bleeding and may actually increase blood loss in women with lower baseline menstrual blood loss 1
The National Institutes of Health recommends tranexamic acid as a highly effective alternative if NSAIDs fail or are contraindicated, reducing menstrual blood loss by 34-59% over 2-3 cycles 1
The Centers for Disease Control and Prevention suggests that the Levonorgestrel-Releasing Intrauterine Device is the most effective medical treatment, reducing menstrual blood loss by 71-95% 1, 3

The American College of Obstetricians and Gynecologists recommends counseling women using Copper IUDs that heavy or prolonged bleeding is common during the first 3-6 months and generally not harmful 2, 4
The National Institutes of Health suggests treating women with uterine fibroids with NSAIDs and estrogen-progestin oral contraceptive pills as first-line medical management 1
The Centers for Disease Control and Prevention advises providing enhanced counseling about expected bleeding patterns, as this improves treatment adherence 1, 2, 3