Management of Menorrhagia with Fibroids

Introduction to Menorrhagia Management

The American College of Radiology recommends that medical management should be trialed before any invasive intervention for menorrhagia, with options including levonorgestrel intrauterine device (LNG-IUD), tranexamic acid, combined oral contraceptives, and non-steroidal anti-inflammatory drugs (NSAIDs) 1, 2
The American College of Radiology suggests that the location and type of fibroid determines whether it can cause bleeding, with submucosal fibroids distorting the endometrial cavity and causing menorrhagia, while serosal/subserosal fibroids do not cause menorrhagia 4, 1

The American College of Radiology recommends levonorgestrel intrauterine device (LNG-IUD) as first-line treatment for menorrhagia, demonstrating high effectiveness for reducing heavy menstrual bleeding and improving quality of life 2
The American College of Radiology suggests that tranexamic acid is an effective non-hormonal antifibrinolytic agent for reducing menstrual blood loss, with a recommended dosage 3, 2
The American College of Radiology recommends combined oral contraceptives as an effective option for regulating cycles and reducing bleeding, particularly with small fibroids 3, 2
The American College of Radiology suggests that NSAIDs are appropriate for symptomatic relief of menorrhagia 2

The American College of Radiology states that myomectomy is not indicated for serosal fibroids that do not cause menorrhagia, and is reserved for symptomatic fibroids causing bulk symptoms or submucosal fibroids causing bleeding 1, 4
The American College of Radiology recommends that hysterectomy is not indicated as a first-line treatment for menorrhagia, and should be reserved for failed medical management or when fertility is complete 5, 1, 2
The American College of Radiology suggests that uterine artery embolization (UAE) is not indicated for serosal fibroids that do not cause menorrhagia, and has a 20-25% symptom recurrence rate at 5-7 years 3, 5, 1, 2