Management of Dizziness Due to Heavy Menstrual Bleeding

Initial Assessment

Evaluate severity of bleeding - bleeding that saturates a large pad or tampon hourly for at least 4 hours requires urgent evaluation 1
Test for pregnancy in all reproductive-age women with abnormal uterine bleeding 1
Check for signs of hemodynamic instability (tachycardia, hypotension) which may indicate significant blood loss 2

The American College of Cardiology recommends a levonorgestrel-releasing intrauterine device (LNG-IUD) as the most effective first-line treatment, reducing menstrual blood loss by 71-95% and addressing the underlying cause of lightheadedness 1, 2
Levonorgestrel-releasing IUD (20 μg/day) reduces menstrual blood loss by 71-95% and provides contraception while treating heavy bleeding 2, 4
Cyclic oral progestin treatment reduces bleeding by approximately 87% and may result in irregular bleeding patterns but often reduces menses to light bleeding 2, 3

NSAIDs (short-term treatment for 5-7 days) can reduce heavy menstrual bleeding, but should be avoided in patients with history of spontaneous coronary artery dissection (SCAD) 1, 5

Endometrial ablation techniques are considered when medical treatment fails and are more effective long-term than oral medical treatments 1, 2, 3
Hysterectomy is a definitive treatment when other options have failed and should be considered only after less invasive procedures have been attempted 6

Patients on antiplatelet therapy may experience worsened menstrual bleeding; reassess the indication for ongoing antiplatelet therapy 2
If bleeding persists and remains unacceptable despite treatment, consider alternative contraceptive methods or referral for surgical management 5