Abnormal Menstrual Bleeding Evaluation and Management
Definition and Prevalence
- Heavy or prolonged bleeding is considered abnormal and may require medical evaluation, according to the Centers for Disease Control and Prevention (CDC) 2, 3
Evaluation
- If clinically indicated, consider underlying gynecological problems when a woman presents with heavy or prolonged bleeding, as recommended by the CDC 3
- Potential underlying conditions to evaluate include displacement of intrauterine devices 3, sexually transmitted diseases 1, pregnancy 2, and new pathologic uterine conditions (polyps or fibroids) 3
- Laboratory tests that may be useful include complete blood count 1 and coagulation studies 3
Management
- For women with unacceptable heavy or prolonged bleeding, NSAIDs for short-term treatment (5-7 days) may be effective, as recommended by the CDC 3, 2
- Hormonal treatments such as low-dose combined oral contraceptives may be considered for short-term management (10-20 days) if medically eligible, according to the CDC 2
- Tranexamic acid may reduce menstrual blood loss, though caution is needed in women with thromboembolic disease, as noted by the CDC 3