Materiały źródłowe

• #1 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  During hysterosonography (his-tur-o-suh-NOG-ruh-fee), you have a thin, flexible tube called a catheter placed in the uterus. Salt water, also called saline, is injected through the flexible tube into the hollow part of the uterus. An ultrasound probe transmits images of the inside of the uterus to a nearby monitor. […] During hysteroscopy (his-tur-OS-kuh-pee), a thin, lighted instrument provides a view of the inside of the uterus. This instrument also is called a hysteroscope. […] Your doctor can make a diagnosis of heavy menstrual bleeding or abnormal uterine bleeding only after it’s known that something else isn’t causing your condition. These causes may include menstrual disorders, medical conditions or medicines. […] Treatment for heavy menstrual bleeding is based on a number of factors. These include: Your overall health and medical history. The cause of the condition and how serious it is. How well you tolerate certain medicines or procedures. The chance that your periods will soon become less heavy. Your plans to have children. How the condition affects your lifestyle. Your opinion or personal choices.

• #1 Treatment with medication | The Royal Women’s Hospital

  https://www.thewomens.org.au/health-information/periods/heavy-periods/treating-heavy-bleeding-with-medication

  Medication is usually the first treatment option that doctors recommend for heavy periods. […] Treatment with medication: can be very effective […] often has fewer and less serious side effects than other treatments […] does not affect your ability to have children or cause early menopause […] is suitable for many women. […] There are six types of medication used to treat heavy menstrual bleeding. […] Tranexamic acid helps your blood to clot, which will reduce the bleeding. […] Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, as prostaglandin seems to contribute to heavy bleeding and pain. […] Hormone-releasing intrauterine device (IUD) is a small, usually plastic device that sits inside your uterus and releases a small amount of progestogen (a drug that acts like the natural hormone progesterone). […] The contraceptive pill releases substances that act like the natural hormones oestrogen and progesterone. […] The progestogen-only pill (POP or mini-pill) also works by stabilising the lining of the uterus.

• #1 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  Medicines for heavy menstrual bleeding may include: Nonsteroidal anti-inflammatory drugs, also called NSAIDs. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), help reduce menstrual blood loss. NSAIDs may also make menstrual cramps less painful. […] Tranexamic acid (Lysteda) helps reduce menstrual blood loss. This medicine only needs to be taken at the time of bleeding. […] Aside from birth control, oral contraceptives can help regulate menstrual cycles and ease menstrual bleeding that is heavy or lasts a long time. […] The natural hormone progesterone can help fix hormone imbalance and reduce heavy menstrual bleeding. The synthetic form of progesterone is called progestin. […] This intrauterine device releases a type of progestin called levonorgestrel. It makes the uterine lining thin and reduces menstrual blood flow and cramping.

• #1 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Progestin is the most frequently prescribed medication for menorrhagia likely because of its safety in the setting of other medical comorbidities and its efficacy. Therapy with this drug results in a significant reduction in menstrual blood flow when used alone. Progestin works as an antiestrogen by minimizing the effects of estrogen on target cells, thereby maintaining the endometrium in a state of nonproliferation. Common adverse effects include weight gain, headaches, edema, and depression. […] High-dose oral progestin options (eg, norethindrone 5-15 mg daily, medroxyprogesterone 5-30 mg daily) can be taken day 5 to 26 of the menstrual cycle or continuously and have shown to reduce blood loss by 80%. In contrast to the combined OCPs, low-dose progestin-only pills (POPs) (eg, 0.35 mg norethindrone) typically for contraceptive use are not usually recommended for treatment of menorrhagia as they are associated with irregular and unpredictable blood loss.

• #1 Patient education: Heavy periods (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/heavy-periods-beyond-the-basics

  Hormonal intrauterine device — There are IUDs that slowly release a hormone, progestin, into the uterus. […] Shot — Depot medroxyprogesterone acetate (brand name: Depo-Provera) is a long-acting form of a progesterone-like hormone, called a progestin. […] Antifibrinolytic medicines — Antifibrinolytic medicines, such as tranexamic acid (brand name: Lysteda), can help to slow menstrual bleeding quickly. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) — Nonsteroidal anti-inflammatory drugs, such as ibuprofen (brand name: Motrin and Advil), naproxen (brand name: Aleve), and mefenamic acid (brand name: Ponstel), can help reduce menstrual bleeding and menstrual cramps. […] Gonadotropin-releasing hormone (GnRH) agonists — GnRH agonists are a type of medicine that can be used to temporarily reduce menstrual bleeding.

• #1 Menorrhagia: Why Is My Period So Heavy?

  https://www.webmd.com/women/heavy-period-causes-treatments

  Menorrhagia Treatment […] Medication is usually the first type of treatment your doctor will prescribe to reduce heavy menstrual bleeding. These include: […] Taking birth control pills or progesterone can alter the balance of hormones in your body, which can put an end to heavy periods. […] Some give off hormones that may help lighten your periods. […] NSAIDs or naproxen sodium can reduce cramping and the amount of blood you lose during your period. […] Tranexamic acid can be taken during your period to lighten blood loss. This medication stops enzymes that dissolve clots in the lining of the uterus. […] Also known as GnRH medications, these help reduce bleeding during your period. Elagolix and Relugolix can be used alone or with hormones to reduce bleeding caused by fibroids and endometriosis.

• #1 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Danazol competes with androgen and progesterone at the receptor level, causing amenorrhea in 4-6 weeks. Danazol can effectively reduce heavy menstrual bleeding, though serious adverse effects limit its use. Common adverse effects produce male characteristics and menopausal symptoms, such as acne, decreasing breast size, and, rarely, lower voice. In addition, danazol is teratogenic and patients need to be counseled about the risks of pregnancy while on this medication. […] Estrogens are given intravenously every 4-6 hours in patients with acute bleeding. A DC procedure may be necessary if no response is noted in 24 hours. Most typically patients will respond within 1-2 doses with cessation of acute bleeding. If menses slows, patients often transition to OCPs to minimize unopposed estrogen exposure.

• #1 Heavy Menstrual Bleeding in Adolescents: ACOG Management Recommendations | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p633.html

  One in five adolescents with heavy menstrual bleeding has an underlying bleeding disorder. […] In hemodynamically stable adolescents with heavy menstrual bleeding, most bleeding can be stopped with high-dose estrogen oral contraceptives taken every six to eight hours, tranexamic acid, or high-dose progesterone. […] Long-term management of heavy menstrual bleeding is best achieved with continuous hormonal contraceptive therapies. […] Approximately 20% of all adolescent girls with heavy menstrual bleeding and 33% of adolescent girls hospitalized for heavy menstrual bleeding have an underlying bleeding disorder. […] Hormonal therapy with intravenous conjugated equine estrogen (Premarin), 25 mg every four to six hours, or monophasic combined oral contraceptives, 30 to 50 mcg of an ethinyl estradiol formulation every six to eight hours, may be used until bleeding has stopped. […] A combination of hormonal and nonhormonal therapies may be necessary to control heavy menstrual bleeding in adolescent girls with bleeding disorders. […] Oral iron supplementation (60 to 120 mg per day) and dietary counseling are first-line therapies for treating iron deficiency anemia.

• #1 Causes and treatment of heavy menstrual bleeding – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/causes-and-treatment-of-heavy-menstrual-bleeding/

  Hormonal and nonhormonal options are available to treat the cause of the bleeding. […] For acute treatment, the preferred therapy is a medroxyprogesterone (Provera) taper — 20 milligrams three times a day for seven days, followed by 20 milligrams daily for 21 days. This is preferred over the combined oral contraceptive pill taper due to risks of side effects from high estrogen dosing such as nausea, vomiting, mood changes and headaches. […] Long-term management starts with treating any underlying cause of the bleeding. Second, there are hormonal and nonhormonal options. Ibuprofen the night before the period and continuing through the first few days can reduce flow by up to 80%. Tranexamic acid, an off-label use for patients under 18, can be used for acute bleeding as well as long-term bleeding at up to 1,300 milligrams three times per day for five days.

• #1 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  If you have heavy menstrual bleeding from taking hormone medicine, you may need to stop or change your medicine. […] You may need surgery for heavy menstrual bleeding if medicines do not help. Treatment options include: Dilation and curettage, also called a DC. In this procedure, your doctor opens your cervix. This also is called dilating the cervix. The doctor then scrapes or suctions tissue from the lining of your uterus. […] The goal of this procedure is to block blood flow to uterine fibroids. Blocking blood flow to fibroids helps to shrink them. […] This procedure shrinks fibroids by targeting and destroying fibroids through ultrasound waves and radiofrequency energy. It needs no incisions. […] This is the surgical removal of uterine fibroids. […] This procedure involves destroying the lining of the uterus. The process of destroying tissue also is known as ablation.

• #1 Endometrial Ablation for Heavy Menstrual Bleeding | FDA

  https://www.fda.gov/medical-devices/surgery-devices/endometrial-ablation-heavy-menstrual-bleeding

  Endometrial ablation is a minimally invasive surgical procedure used to treat heavy menstrual bleeding (periods). The procedure works by ablating (destroying) the tissue in the lining of the uterus, which is called the endometrium. Because the endometrium is the tissue that causes bleeding, destroying this tissue may reduce menstrual bleeding to normal or lighter levels. […] Heavy menstrual bleeding is a common problem. About one out of three patients who get their period seek treatment for heavy menstrual bleeding. […] The FDA has approved endometrial ablation devices for premenopausal patients with heavy menstrual bleeding due to benign (non-cancerous) causes for whom childbearing is complete. […] The main potential benefit of the procedure is the reduction in menstrual bleeding and improvement in quality of life.

• #1 About Heavy Menstrual Bleeding | Bleeding Disorders in Women | CDC

  https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html

  Hormone therapy (drugs that contain estrogen and/or progesterone). To reduce the amount of bleeding. […] Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed. […] Surgical Treatment […] Dilation and curettage (DC). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. […] Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow. […] Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. […] Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus.

• #1 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Hysterectomy provides a definitive cure for menorrhagia, often utilized for people who do not desire future fertility and have failed medical and/or other surgical options. Hysterectomies can be performed vaginally, laparoscopically (or laparoscopically assisted vaginal hysterectomy), robotically, or abdominally. The route of hysterectomy can be influenced by the size and shape of the uterus, accessibility of the uterus, surrounding pelvic disease, other concurrent procedures, surgeon preference and training, available technology and support, acuity of surgery, patient preference, and many other clinical factors. The procedure is more expensive and results in greater morbidity than ablative procedures. The mortality rate ranges from 0.1-1.1 cases per 1000 procedures and 1/30 women will experience a major adverse event. Risks include those usually associated with major surgery.

• #1 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Uterine fibroids may cause heavier than normal menstrual bleeding or bleeding that goes on for a long time. […] These small growths on the lining of the uterus may cause menstrual bleeding that is heavy or lasts for a long time. […] In this condition, glands from the lining of the uterus grow into the wall of the uterus itself. This can cause heavy bleeding and painful periods. […] Heavy menstrual bleeding can cause anemia related to blood loss. Anemia is a condition in which the body lacks enough red blood cells to carry oxygen to tissues. […] Along with heavy menstrual bleeding, you might have painful menstrual cramps. This also is known as dysmenorrhea. Talk to your doctor if your cramps make it hard to do your daily activities.

• #1 Dilatation & curettage for heavy menstrual bleeding – EBI

  https://ebi.aomrc.org.uk/interventions/dilatation-curettage-for-heavy-menstrual-bleeding/

  Dilation and curettage (DC) is a minor surgical procedure where the opening of the womb (cervix) is widened (dilatation) and the lining of the womb is scraped out (curettage). […] DC should not be used for diagnosis or treatment for heavy menstrual bleeding because it is clinically ineffective. […] Medication and intrauterine systems (IUS) can be used to treat heavy periods. […] NICE guidelines recommend that DC is not offered as a treatment option for heavy menstrual bleeding. There is very little evidence to suggest that DC works to treat heavy periods and the one study identified by NICE showed the effects were only temporary. […] There are no diagnostic or treatment benefits with dilation and curettage. A hysterectomy for patients with heavy periods should only be considered in certain circumstances.

• #1 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  Menorrhagia or heavy menstrual bleeding is a common disorder among people who menstruate. Talk to your provider about treatment options if heavy bleeding during your period affects your quality of life. […] Contact a healthcare provider if any of these scenarios apply to you. They can evaluate your symptoms and figure out whats causing you to have heavy periods. Then, they can recommend treatment options to manage heavy blood flow during your period. […] Treatment depends on whats causing your bleeding, how severe your bleeding is, your health, age and medical history. […] Talk with your provider about your health concerns and your goals for treatment so they can recommend the best approach. […] Healthcare providers recommend medication before surgical treatment. Some possible options include: Iron supplements improve your iron levels. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can ease your cramps and reduce your bleeding. Birth control (pills, vaginal ring, patch, IUDs) may help make your periods more regular and lighten your blood flow. Hormone replacement therapy (HRT) can help balance the amount of estrogen and progesterone in your body so that your menstrual flow isnt as heavy.

• #1 Heavy menstrual bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Heavy_menstrual_bleeding

  Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). […] Treatment depends on the cause, severity, and interference with quality of life. Initial treatment often involves birth control pills. Tranexamic acid, danazol, hormonal intrauterine device, and painkillers (NSAIDs) are also helpful. Surgery can be effective for those whose symptoms are not well-controlled with other treatments. […] The first line treatment option for those with HMB and no identified pathology, fibroids less than 3 cm in diameter, and/or suspected or confirmed adenomyosis is the levonorgestrel-releasing intrauterine system (LNG-IUS). Clinical trial evidence suggests that the LNG-IUS may be better than other medical therapy in terms of HMB and quality of life.

• #1 Heavy Menstrual Bleeding: Understanding Common Causes and Your Treatment Options | Urogynecologists located in Oak Lawn, IL | Chicago Center for Women’s Health

  https://www.myccwh.com/blog/heavy-menstrual-bleeding-understanding-common-causes-and-your-treatment-options

  Heavy periods also occur as a symptom of hereditary blood-clotting disorders, such as hemophilia or von Willebrand disease. […] You can also experience a heavy period resulting from issues related to pregnancy, such as miscarriage or ectopic pregnancy. […] Heavy periods can occur as a side effect from certain prescribed medications, including blood thinners (anticoagulants), anti-inflammatory medications, aspirin, and hormonal medications. […] You may also experience heavy periods as a side effect of copper intrauterine devices (IUDs). […] Certain birth control pills can help reduce blood flow, regulate your period, and in some cases, halt the bleeding altogether. […] Hormone therapy can help reduce the bleeding. […] Drugs, such as ibuprofen and naproxen, can help reduce the bleeding and aid in relieving menstrual cramps.

• #1 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Medical therapy for menorrhagia should be tailored to the individual. Factors taken into consideration when selecting the appropriate medical treatment include the patients clinical stability, acuity of bleeding, patient’s age, coexisting medical diseases and allergies, family history, and desire for fertility. Medication cost and adverse effects are also considered because they may play a direct role in patient compliance. Options for hormonal therapy include combined oral contraceptive pills, GnRH agonists and antagonists, hormonal patches or vaginal rings, progestin-only pills, depot medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine device, and the etonogestrel implant, according to American College of Obstetricians and Gynecologists. The Centers for Disease Control and Preventions Medical Eligibility Criteria for Contraceptive Use and US Food and Drug Administration (FDA) labeling information can be useful in determining the contraindications to hormonal methods based on medical comorbidities.

• #1 Adolescent gynaecology – Heavy menstrual bleeding

  https://www.rch.org.au/clinicalguide/guideline_index/adolescent_gynaecology_menorrhagia/

  The most common cause of Heavy Menstrual Bleeding (HMB) in adolescents is anovulatory cycles. […] Mild bleeding with a normal haemoglobin can be managed with reassurance, non-hormonal treatments and observation. […] Hormonal therapy aims to stabilise the endometrium. […] Treatment is targeted to the underlying cause; for anovulatory bleeding, the objective is to stabilise the endometrium (oestrogen for initial haemostasis and progestins for extended endometrial stability). […] Consider non-hormonal management such as regular NSAIDs and tranexamic acid during menses. […] Hormonal Therapy: Combination estrogen-progesterone oral contraceptive pills can decrease flow by 50% and is effective for anovulation or irregular menses. […] All patients may benefit from iron supplements. […] Tranexamic acid taken day 15 of menses can decrease flow by 25-50%. […] All NSAIDs can decrease flow if taken regularly during menstruation. […] Progestins generate a secretory endometrium and are good for anovulation (infrequent periods) due to the lack of progesterone.

• #1 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  Hormone therapy can be helpful for heavy menstrual bleeding that occurs during perimenopause. Before deciding to use hormone therapy, it is important to weigh the benefits and risks (increased risk of heart attack, stroke, and cancer). […] Tranexamic acid is a prescription medication that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period. […] If medication does not reduce your bleeding, a surgical procedure may be recommended: Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation.

• #1 Heavy Menstrual Bleeding: Symptoms and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/heavy-menstrual-bleeding

  Oral contraceptives, vaginal rings, patches, or IUDs may promote regular periods and reduce blood flow. […] Hormone replacement therapy can balance estrogen and progesterone levels, potentially reducing heavy menstrual flow. […] Antifibrinolytic medications, such as tranexamic acid, can swiftly slow menstrual bleeding by aiding the blood clotting system. […] Gonadotropin-releasing hormone (GnRH) agonists can temporarily halt or lessen bleeding by inhibiting ovulation. […] If you plan for a pregnancy in the next few months, nonsteroidal anti-inflammatory drugs (NSAIDs) or antifibrinolytic medicines would be suitable. […] If pregnancy consideration is far off in the future, hormonal birth control methods, a hormonal IUD, progestin pills, or injectable progestin may be viable options.

• #1 Treatment for Heavy Menstrual Cycles in New Port Richey, FL

  https://trinityurogynecology.com/services/heavy-menstrual-cycles/

  Our approach to treating heavy menstrual bleeding is personalized and comprehensive. Here’s what to expect: […] Hormonal therapies, such as birth control pills, patches, or intrauterine devices (IUDs), help regulate periods and reduce bleeding. Non-hormonal options, like tranexamic acid or nonsteroidal anti-inflammatory drugs (NSAIDs), can also be effective. […] Endometrial ablation removes or destroys the uterine lining to reduce or stop bleeding. Hysteroscopic surgery can remove fibroids or polyps, contributing to heavy bleeding. […] In severe cases, a hysterectomy (removal of the uterus) may be considered as a permanent solution. Less invasive alternatives like uterine artery embolization may be appropriate for specific causes like fibroids. […] Regular check-ups ensure the effectiveness of the treatment plan and allow for adjustments if necessary.

• #1 Periods – heavy bleeding | Healthify

  https://healthify.nz/health-a-z/p/periods-heavy-bleeding

  Surgery is only considered when medical treatments have not been effective. Surgical options include: endometrial ablation, hysterectomy, other surgical options. […] If you have heavy periods each month, one of the key things to watch out for is iron deficiency. One of the most common causes of iron deficiency is prolonged or heavy periods. This can leave you feeling tired and lacking energy. In some cases, this can even lead to anaemia. […] Ask your doctor or nurse if you need a blood test to check your ferritin (iron) and full blood count. If your results indicate your iron is low, you may need to also take iron supplements.

• #1 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  Heavy menstrual bleeding is very common. About one third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. If you are worried that your menstrual bleeding is too heavy, tell your obstetrician-gynecologist (ob-gyn). […] Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems. […] Medications often are tried first to treat heavy menstrual bleeding: Heavy bleeding caused by problems with ovulation, endometriosis, PCOS, and fibroids often can be managed with certain hormonal birth control methods. Depending on the type, these methods can lighten menstrual flow, help make periods more regular, or even stop bleeding completely.

• #2 Heavy periods: Learn More – What are the treatment options for heavy periods? – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279293/

  There are various treatment options for women who have problems related to heavy periods, including medication, hormonal contraceptives and surgery. Knowing about the pros and cons of the different options can make it easier to choose a suitable treatment. […] Hormonal contraceptives like birth control pills or hormonal coils (IUDs) affect the menstrual cycle and lessen the amount of bleeding. If one of these doesn’t help, it is usually possible to try out another one that is used in a different way or has a different active ingredient in it. Sometimes surgery can help. […] Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and diclofenac, are often used for the relief of period pain and cramps, and also for heavy periods. They not only reduce the pain, but can also lessen the bleeding somewhat.

• #2 Heavy menstrual bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Heavy_menstrual_bleeding

  Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). […] Treatment depends on the cause, severity, and interference with quality of life. Initial treatment often involves birth control pills. Tranexamic acid, danazol, hormonal intrauterine device, and painkillers (NSAIDs) are also helpful. Surgery can be effective for those whose symptoms are not well-controlled with other treatments. […] The first line treatment option for those with HMB and no identified pathology, fibroids less than 3 cm in diameter, and/or suspected or confirmed adenomyosis is the levonorgestrel-releasing intrauterine system (LNG-IUS). Clinical trial evidence suggests that the LNG-IUS may be better than other medical therapy in terms of HMB and quality of life.

• #2 Heavy periods (menorrhagia) | healthdirect

  https://www.healthdirect.gov.au/heavy-periods

  Heavy periods can generally be managed with medicines or surgery. […] Your doctor will recommend the best option for you. This will depend on: your age, your health, your medical history, whether you would like to be pregnant in the future, how successful other treatments have been. […] Medicines and hormones used to treat heavy periods can include: Tranexamic acid which helps your blood to clot. Non-steroidal anti-inflammatory drugs (NSAIDS) to reduce the amount of prostaglandins in the lining of your uterus (which can cause heavy periods). A hormone-releasing intrauterine device (IUD) which stabilises the lining of your uterus. The oral contraceptive pill (’the pill’) which stabilises the lining of your uterus. The progestogen-only pill which stabilises the lining of your uterus. […] Sometimes heavy periods are treated with surgery or other procedures. This can treat the cause of your heavy bleeding. […] Procedures can be done to remove: the lining of your uterus (an endometrial ablation), fibroids in your uterus, your whole uterus (a hysterectomy).

• #2 GnRH Agonists for Heavy Periods (PDF Download)

  https://gynqi.com/heavy-menstrual-bleeding-medical-management/

  The Levonorgestrel Intrauterine System (LNG-IUS) offers significant benefits for managing heavy menstrual bleeding (HMB), with a 70-97% reduction in menstrual blood, and the potential for 20-80% of patients to experience amenorrhea (absence of menstruation) after one year of use. […] Combined Hormonal Contraceptives (CHCs), provided in a patch, vaginal ring, or pill form, can reduce menstrual bleeding by 20-50% and are associated with less period pain (dysmenorrhea) and pre-menstrual symptoms. […] Oral progestin Norethisterone/Norethindrone acetate (NETA) can reduce menstrual bleeding by up to 87%. […] Depot medroxyprogesterone acetate (DMPA) is an effective method that often leads to amenorrhea, with 60% of patients experiencing no periods within the first 12 months and 68% by 24 months.

• #2 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  The levonorgestrel intrauterine system (IUD) reduces menstrual blood loss by as much as 97%. It is comparable to transcervical resection of the endometrium for reduction of menstrual bleeding. Adverse effects include discomfort with insertion, spontaneous expulsion, and abnormal uterine bleeding or spotting. […] These agents are used on a short-term basis in selected patients due to high costs and severe adverse effects. GnRH agonists and antagonists can be effective in reducing menstrual blood flow. They inhibit pituitary release of FSH and LH, resulting in hypogonadism. A prolonged hypoestrogenic state leads to bone demineralization and reduction of high-density lipoprotein (HDL) cholesterol. Notably, most patients experience a flare in symptomatology with initial treatment that resolves with continued use.

• #2 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Danazol competes with androgen and progesterone at the receptor level, causing amenorrhea in 4-6 weeks. Danazol can effectively reduce heavy menstrual bleeding, though serious adverse effects limit its use. Common adverse effects produce male characteristics and menopausal symptoms, such as acne, decreasing breast size, and, rarely, lower voice. In addition, danazol is teratogenic and patients need to be counseled about the risks of pregnancy while on this medication. […] Estrogens are given intravenously every 4-6 hours in patients with acute bleeding. A DC procedure may be necessary if no response is noted in 24 hours. Most typically patients will respond within 1-2 doses with cessation of acute bleeding. If menses slows, patients often transition to OCPs to minimize unopposed estrogen exposure.

• #2 In-Office Treatment of Menorrhagia (Heavy Periods) – MacArthur Medical Center

  https://macarthurmc.com/specialties/heavyperiods/

  The Hydro ThermAblator System (HTA System) is a device that allows your gynecologist to perform endometrial ablation on an outpatient basis. […] Your physician will give you pain medication before the procedure to reduce cramping during or after the procedure. […] You should not have this procedure if you desire pregnancy in the future. Endometrial ablation, however, does not prevent you from becoming pregnant and such a pregnancy would be high risk for both mother and fetus. Contraception or sterilization should be used after this treatment since pregnancy can still occur. Please discuss the different options with your physician. […] Ask your doctor if HTA ablation is right for you.

• #2 Treatment of Menorrhagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0615/p1813.html

  Ablation methods (transcervical resection and balloon ablation) resulted in greater reductions of mean menstrual blood loss and higher amenorrhea rates than the levonorgestrel-releasing IUD. […] Hysterectomy is a definitive treatment for menorrhagia, but there is risk of surgical morbidity and the economic cost is high. […] Although endometrial resection procedures result in faster return to normal activities than hysterectomy, they are associated with a reintervention rate of up to 22 percent, so the cost difference between hysterectomy and endometrial resection narrows over time. […] Women who tolerate menstrual bleeding and wish to maintain fertility can try medical therapy with continuous progestin on days 5 to 26 of the menstrual cycle. […] The levonorgestrel-releasing IUD is an effective long-term option if future childbearing is desired. […] When medical and transcervical resection (ablation) therapy for menorrhagia were compared, women preferred endometrial resection. […] Hysterectomy is a well-suited option for women who do not desire further childbearing or menstrual bleeding and are willing to assume the risk of surgery.

• #2 Heavy Menstrual Bleeding: Understanding Common Causes and Your Treatment Options | Urogynecologists located in Oak Lawn, IL | Chicago Center for Women’s Health

  https://www.myccwh.com/blog/heavy-menstrual-bleeding-understanding-common-causes-and-your-treatment-options

  With heavy bleeding due to fibroids, gonadotropin-releasing hormone agonists can help by reducing the size of the fibroids. […] Tranexamic acid is another option that may be able to reduce bleeding. […] This procedure entails destroying a thin layer of the uterus lining to reduce or stop the bleeding. […] A uterine artery embolization blocks the vessels that provide blood flow to the fibroids. […] A myomectomy removes the fibroids without removing the uterus. […] Hysterectomy involves removing the uterus and thus removing the fibroids.

• #2 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  UAE is considered an acceptable alternative to surgery for menorrhagia associated with fibroids, and research supports treatment of adenomyosis. Common reasons to choose UAE include desiring a nonsurgical approach, medical contraindications to surgery, uterine preservation, faster recovery, and minimally invasive technique. Common complications include fibroid expulsion, premature ovarian failure, infection, DVT, and postembolization syndrome.

• #2 Heavy Menstrual Bleeding in Adolescents: ACOG Management Recommendations | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p633.html

  One in five adolescents with heavy menstrual bleeding has an underlying bleeding disorder. […] In hemodynamically stable adolescents with heavy menstrual bleeding, most bleeding can be stopped with high-dose estrogen oral contraceptives taken every six to eight hours, tranexamic acid, or high-dose progesterone. […] Long-term management of heavy menstrual bleeding is best achieved with continuous hormonal contraceptive therapies. […] Approximately 20% of all adolescent girls with heavy menstrual bleeding and 33% of adolescent girls hospitalized for heavy menstrual bleeding have an underlying bleeding disorder. […] Hormonal therapy with intravenous conjugated equine estrogen (Premarin), 25 mg every four to six hours, or monophasic combined oral contraceptives, 30 to 50 mcg of an ethinyl estradiol formulation every six to eight hours, may be used until bleeding has stopped. […] A combination of hormonal and nonhormonal therapies may be necessary to control heavy menstrual bleeding in adolescent girls with bleeding disorders. […] Oral iron supplementation (60 to 120 mg per day) and dietary counseling are first-line therapies for treating iron deficiency anemia.

• #2 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Surgical management has been the standard of treatment in menorrhagia due to structural causes (eg, fibroids) or when medical therapy fails to alleviate symptoms. Surgical treatment ranges from a simple DC to a total hysterectomy. […] Surgical management is based on the acuity and severity of bleeding, contraindications and response to medical management, and the underlying etiology of bleeding. Choosing a surgical modality is a shared decision-making process, which depends on the previously mentioned considerations, future fertility, and the patients goals. […] A DC should be used for diagnostic purposes. It is not used for treatment because it provides only short-term relief, typically 1-2 months, though can be used to stop acute bleeding episodes in specific circumstances. […] Endometrial ablation is a surgical procedure that destroys the endometrium. For many, this procedure provides a minimally invasive and effective option for menorrhagia and can be used for acute uterine bleeding. Ablation is typically considered if a patient has failed medical therapy or desires more definitive management, and/or other options are contraindicated.

• #2 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  Menorrhagia or heavy menstrual bleeding is a common disorder among people who menstruate. Talk to your provider about treatment options if heavy bleeding during your period affects your quality of life. […] Contact a healthcare provider if any of these scenarios apply to you. They can evaluate your symptoms and figure out whats causing you to have heavy periods. Then, they can recommend treatment options to manage heavy blood flow during your period. […] Treatment depends on whats causing your bleeding, how severe your bleeding is, your health, age and medical history. […] Talk with your provider about your health concerns and your goals for treatment so they can recommend the best approach. […] Healthcare providers recommend medication before surgical treatment. Some possible options include: Iron supplements improve your iron levels. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can ease your cramps and reduce your bleeding. Birth control (pills, vaginal ring, patch, IUDs) may help make your periods more regular and lighten your blood flow. Hormone replacement therapy (HRT) can help balance the amount of estrogen and progesterone in your body so that your menstrual flow isnt as heavy.

• #2 Heavy Menstrual Bleeding: Symptoms and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/heavy-menstrual-bleeding

  Oral contraceptives, vaginal rings, patches, or IUDs may promote regular periods and reduce blood flow. […] Hormone replacement therapy can balance estrogen and progesterone levels, potentially reducing heavy menstrual flow. […] Antifibrinolytic medications, such as tranexamic acid, can swiftly slow menstrual bleeding by aiding the blood clotting system. […] Gonadotropin-releasing hormone (GnRH) agonists can temporarily halt or lessen bleeding by inhibiting ovulation. […] If you plan for a pregnancy in the next few months, nonsteroidal anti-inflammatory drugs (NSAIDs) or antifibrinolytic medicines would be suitable. […] If pregnancy consideration is far off in the future, hormonal birth control methods, a hormonal IUD, progestin pills, or injectable progestin may be viable options.

• #2 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  If medication doesnt improve your symptoms, your provider may recommend a surgical procedure. The type of procedure they recommend depends on the cause of your bleeding. […] Your provider will recommend the treatment that works best to address the cause of your bleeding. Treatment may begin with medication and then progress to minor procedures and surgical options. Speak with your provider to decide which options work best for you. […] If you think you have menorrhagia, its important to see a healthcare provider to treat it. […] Yes, its possible that menorrhagia can go away without treatment. Its best to talk to your provider about if this may be the case for you. Menorrhagia may be temporary and get better without medical intervention. But, in many cases, an underlying condition is causing heavy menstrual bleeding. You may not have relief from heavy period bleeding until you get treatment for the condition.

• #2 Treatment with medication | The Royal Women’s Hospital

  https://www.thewomens.org.au/health-information/periods/heavy-periods/treating-heavy-bleeding-with-medication

  Medication is usually the first treatment option that doctors recommend for heavy periods. […] Treatment with medication: can be very effective […] often has fewer and less serious side effects than other treatments […] does not affect your ability to have children or cause early menopause […] is suitable for many women. […] There are six types of medication used to treat heavy menstrual bleeding. […] Tranexamic acid helps your blood to clot, which will reduce the bleeding. […] Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, as prostaglandin seems to contribute to heavy bleeding and pain. […] Hormone-releasing intrauterine device (IUD) is a small, usually plastic device that sits inside your uterus and releases a small amount of progestogen (a drug that acts like the natural hormone progesterone). […] The contraceptive pill releases substances that act like the natural hormones oestrogen and progesterone. […] The progestogen-only pill (POP or mini-pill) also works by stabilising the lining of the uterus.

• #2 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  You cant prevent all causes of heavy period bleeding. But talking with your healthcare provider to get a diagnosis and treatment can help you manage your bleeding so that it doesnt interfere with your quality of life. […] With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being. […] Just because heavy periods are common doesnt mean that you have to live with the discomfort they cause. If managing your blood flow is getting in the way of your emotional and physical well-being, speak with your provider. They can provide a care path that will provide relief and get you back to living the life you want to live, even when youre on your period.

• #3 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  Medicines for heavy menstrual bleeding may include: Nonsteroidal anti-inflammatory drugs, also called NSAIDs. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), help reduce menstrual blood loss. NSAIDs may also make menstrual cramps less painful. […] Tranexamic acid (Lysteda) helps reduce menstrual blood loss. This medicine only needs to be taken at the time of bleeding. […] Aside from birth control, oral contraceptives can help regulate menstrual cycles and ease menstrual bleeding that is heavy or lasts a long time. […] The natural hormone progesterone can help fix hormone imbalance and reduce heavy menstrual bleeding. The synthetic form of progesterone is called progestin. […] This intrauterine device releases a type of progestin called levonorgestrel. It makes the uterine lining thin and reduces menstrual blood flow and cramping.

• #3 GnRH Agonists for Heavy Periods (PDF Download)

  https://gynqi.com/heavy-menstrual-bleeding-medical-management/

  The Levonorgestrel Intrauterine System (LNG-IUS) offers significant benefits for managing heavy menstrual bleeding (HMB), with a 70-97% reduction in menstrual blood, and the potential for 20-80% of patients to experience amenorrhea (absence of menstruation) after one year of use. […] Combined Hormonal Contraceptives (CHCs), provided in a patch, vaginal ring, or pill form, can reduce menstrual bleeding by 20-50% and are associated with less period pain (dysmenorrhea) and pre-menstrual symptoms. […] Oral progestin Norethisterone/Norethindrone acetate (NETA) can reduce menstrual bleeding by up to 87%. […] Depot medroxyprogesterone acetate (DMPA) is an effective method that often leads to amenorrhea, with 60% of patients experiencing no periods within the first 12 months and 68% by 24 months.

• #3 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Progestin is the most frequently prescribed medication for menorrhagia likely because of its safety in the setting of other medical comorbidities and its efficacy. Therapy with this drug results in a significant reduction in menstrual blood flow when used alone. Progestin works as an antiestrogen by minimizing the effects of estrogen on target cells, thereby maintaining the endometrium in a state of nonproliferation. Common adverse effects include weight gain, headaches, edema, and depression. […] High-dose oral progestin options (eg, norethindrone 5-15 mg daily, medroxyprogesterone 5-30 mg daily) can be taken day 5 to 26 of the menstrual cycle or continuously and have shown to reduce blood loss by 80%. In contrast to the combined OCPs, low-dose progestin-only pills (POPs) (eg, 0.35 mg norethindrone) typically for contraceptive use are not usually recommended for treatment of menorrhagia as they are associated with irregular and unpredictable blood loss.

• #3 GnRH Agonists for Heavy Periods (PDF Download)

  https://gynqi.com/heavy-menstrual-bleeding-medical-management/

  The use of this treatment can lead to an 80% reduction in menstrual bleeding, with 20% of patients experiencing no periods (amenorrhea) and another 20% experiencing infrequent periods (oligomenorrhea). […] Leuprolide acetate (Lupron) and Goserelin (Zoladex) can lead to amenorrhea in up to 89% of patients within 3 to 4 weeks of the first injection, making them effective treatments for managing heavy menstrual bleeding. […] Heavy menstrual bleeding can significantly impact daily life, but various treatment options are available to help manage your symptoms effectively.

• #3 Non-Hormonal Treatments for Heavy Menstrual Bleeding (HMB) | North Shore Gynecology

  https://northshoregynecology.com/health-topics/non-hormonal-treatments-for-heavy-menstrual-bleeding-hmb/

  Endometrial ablation is a minimally invasive surgical procedure that involves cauterization or freezing of the endometrial lining. It is not recommended for women who desire to have a future pregnancy, as it can interfere with implantation of the placenta. It is highly effective in most women, and can be done in the office setting. On average, 95% of women have significantly less bleeding, and many stop having menstrual bleeding altogether. […] Endometrial ablation procedures have significantly reduced the number of hysterectomies for heavy menstrual bleeding in the United States and internationally. […] Many women suffer from heavy menstrual bleeding, and this can result in absenteeism from work or school, as well as significantly impacting a woman’s quality of life. Since there are many potential causes and treatments available for heavy menstrual bleeding, it is important for you to be evaluated by your healthcare provider so that together you can individualize a treatment option that best suits your needs.

• #3 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Hysterectomy provides a definitive cure for menorrhagia, often utilized for people who do not desire future fertility and have failed medical and/or other surgical options. Hysterectomies can be performed vaginally, laparoscopically (or laparoscopically assisted vaginal hysterectomy), robotically, or abdominally. The route of hysterectomy can be influenced by the size and shape of the uterus, accessibility of the uterus, surrounding pelvic disease, other concurrent procedures, surgeon preference and training, available technology and support, acuity of surgery, patient preference, and many other clinical factors. The procedure is more expensive and results in greater morbidity than ablative procedures. The mortality rate ranges from 0.1-1.1 cases per 1000 procedures and 1/30 women will experience a major adverse event. Risks include those usually associated with major surgery.

• #3 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  UAE is considered an acceptable alternative to surgery for menorrhagia associated with fibroids, and research supports treatment of adenomyosis. Common reasons to choose UAE include desiring a nonsurgical approach, medical contraindications to surgery, uterine preservation, faster recovery, and minimally invasive technique. Common complications include fibroid expulsion, premature ovarian failure, infection, DVT, and postembolization syndrome.

• #3 Heavy Periods: Causes, Symptoms and Treatment | 700 Children’s Blog

  https://www.nationwidechildrens.org/family-resources-education/700childrens/2016/10/heavy-menstrual-bleeding-what-girls-and-parents-need-to-know

  Heavy menstrual bleeding is a common problem during adolescence. […] Patients and health care providers should consider a diagnosis of heavy menstrual bleeding when any of the following symptoms occur: Menses lasts more than seven days. […] Many of the young women we see in our clinics have iron deficiency or iron deficiency anemia, a common complication of heavy menstrual bleeding. Dietary changes and use of oral iron supplements are always the first line of intervention for such patients. […] For symptomatic patients not responding to oral therapy, or who experience intolerable side effects from oral iron, intravenous iron is a potential option that we offer to our patients. […] Encouraging teens to give their health care provider an accurate description of their menstrual cycles, and to freely share any concerns regarding the duration or heaviness of their menstrual bleeding, are the first steps to avoid delays in the diagnosis of bleeding disorders.

• #3 Dilatation & curettage for heavy menstrual bleeding – EBI

  https://ebi.aomrc.org.uk/interventions/dilatation-curettage-for-heavy-menstrual-bleeding/

  Dilation and curettage (DC) is a minor surgical procedure where the opening of the womb (cervix) is widened (dilatation) and the lining of the womb is scraped out (curettage). […] DC should not be used for diagnosis or treatment for heavy menstrual bleeding because it is clinically ineffective. […] Medication and intrauterine systems (IUS) can be used to treat heavy periods. […] NICE guidelines recommend that DC is not offered as a treatment option for heavy menstrual bleeding. There is very little evidence to suggest that DC works to treat heavy periods and the one study identified by NICE showed the effects were only temporary. […] There are no diagnostic or treatment benefits with dilation and curettage. A hysterectomy for patients with heavy periods should only be considered in certain circumstances.

• #3 How to Stop Heavy Periods: 16 Diet Tips, Drugs, and Procedures

  https://www.healthline.com/health/how-to-stop-heavy-periods

  This minimally invasive procedure can destroy the uterine lining. […] This minimally invasive procedure is used to remove the uterine lining. […] This is a major surgery where a doctor will remove the entire uterus. […] If your symptoms persist, they could be a sign of a more serious underlying condition. […] They can help determine the reason for bleeding and create a care plan suited to your lifestyle and preferences.

• #3 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  If you have heavy menstrual bleeding from taking hormone medicine, you may need to stop or change your medicine. […] You may need surgery for heavy menstrual bleeding if medicines do not help. Treatment options include: Dilation and curettage, also called a DC. In this procedure, your doctor opens your cervix. This also is called dilating the cervix. The doctor then scrapes or suctions tissue from the lining of your uterus. […] The goal of this procedure is to block blood flow to uterine fibroids. Blocking blood flow to fibroids helps to shrink them. […] This procedure shrinks fibroids by targeting and destroying fibroids through ultrasound waves and radiofrequency energy. It needs no incisions. […] This is the surgical removal of uterine fibroids. […] This procedure involves destroying the lining of the uterus. The process of destroying tissue also is known as ablation.

• #4 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medical therapy in ovulatory menorrhagia. Studies show an average reduction of 20-46% in menstrual blood flow. NSAIDs reduce prostaglandin levels by inhibiting cyclooxygenase and decreasing the ratio of prostacyclin to thromboxane. NSAIDs are often ingested for the first 5 days of a menstrual cycle, although the use is limited by the most common adverse effect of stomach upset. NSAIDs should be avoided in patients with an allergy or with peptic ulcer and renal disease. […] Oral contraceptive pills (OCPs) are a popular first-line therapy for women who desire contraception in addition to management of abnormal uterine bleeding (AUB). Menstrual blood loss is reduced as effectively as NSAIDs secondary to endometrial atrophy. OCPs suppress pituitary gonadotropin release and thus ovulation. OCPs can be used in continuous or extended fashion for menorrhagia and multidose regimens for acute AUB. Common adverse effects include breast tenderness, breakthrough bleeding, nausea, and related weight gain in some individuals. The vaginal ring and transdermal patch require less frequent administration than daily OCPs. Both the ring and patch can be used similarly to OCPs, with a standard 28-day cycle, extended cycles, or continuously. Patients should be counseled about the various routes of administration for combined contraceptives and the benefits and disadvantages of each.

• #4 Heavy periods: Learn More – What are the treatment options for heavy periods? – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279293/

  According to scientific research comparing the various medications and hormonal treatments, hormonal coils are the most effective at reducing bleeding and the related problems. The second most effective of these treatments is tranexamic acid. […] Surgery may be necessary if benign growths in or on the wall of the womb (fibroids or polyps) are causing heavy periods. […] One possible treatment for heavy periods involves removing the lining of the womb (the endometrium). […] If your periods are very heavy and distressing, and previous treatments weren’t successful, your doctor may suggest a hysterectomy (surgery to remove your womb). […] A comparison of these two options shows that removing the womb completely (hysterectomy) is the more effective treatment for heavy periods.

• #4 GnRH Agonists for Heavy Periods (PDF Download)

  https://gynqi.com/heavy-menstrual-bleeding-medical-management/

  The Levonorgestrel Intrauterine System (LNG-IUS) offers significant benefits for managing heavy menstrual bleeding (HMB), with a 70-97% reduction in menstrual blood, and the potential for 20-80% of patients to experience amenorrhea (absence of menstruation) after one year of use. […] Combined Hormonal Contraceptives (CHCs), provided in a patch, vaginal ring, or pill form, can reduce menstrual bleeding by 20-50% and are associated with less period pain (dysmenorrhea) and pre-menstrual symptoms. […] Oral progestin Norethisterone/Norethindrone acetate (NETA) can reduce menstrual bleeding by up to 87%. […] Depot medroxyprogesterone acetate (DMPA) is an effective method that often leads to amenorrhea, with 60% of patients experiencing no periods within the first 12 months and 68% by 24 months.

• #4 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  The levonorgestrel intrauterine system (IUD) reduces menstrual blood loss by as much as 97%. It is comparable to transcervical resection of the endometrium for reduction of menstrual bleeding. Adverse effects include discomfort with insertion, spontaneous expulsion, and abnormal uterine bleeding or spotting. […] These agents are used on a short-term basis in selected patients due to high costs and severe adverse effects. GnRH agonists and antagonists can be effective in reducing menstrual blood flow. They inhibit pituitary release of FSH and LH, resulting in hypogonadism. A prolonged hypoestrogenic state leads to bone demineralization and reduction of high-density lipoprotein (HDL) cholesterol. Notably, most patients experience a flare in symptomatology with initial treatment that resolves with continued use.

• #4 Treatment Options for Heavy Menstrual Bleeding > Beacon Health System

  https://www.beaconhealthsystem.org/treatment-options-for-heavy-menstrual-bleeding/

  Heavy bleeding is a common problem that affects about 1 in 5 women. […] Endometrial ablation can be indicated for pre-menopausal women with excessive menstrual bleeding due to benign causes for whom childbearing is complete. […] An improved endometrial ablation treatment technology is now available for women with excessive menstrual bleeding, or menorrhagia. […] The endometrial ablation procedure uses a heat device to ablate (destroy) the endometrium, or lining of the uterus. […] In an international multi-center clinical trial conducted by the manufacturer of this new and improved ablation instrumentation, 92% of patients treated with endometrial ablation reported reductions of bleeding to a less than normal level and 66% reported zero bleeding, at 12 months post-procedure. […] If you are needlessly suffering from excessive menstrual bleeding, please schedule a consultation appointment to find out if endometrial ablation is right for you.

• #4 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Hysterectomy provides a definitive cure for menorrhagia, often utilized for people who do not desire future fertility and have failed medical and/or other surgical options. Hysterectomies can be performed vaginally, laparoscopically (or laparoscopically assisted vaginal hysterectomy), robotically, or abdominally. The route of hysterectomy can be influenced by the size and shape of the uterus, accessibility of the uterus, surrounding pelvic disease, other concurrent procedures, surgeon preference and training, available technology and support, acuity of surgery, patient preference, and many other clinical factors. The procedure is more expensive and results in greater morbidity than ablative procedures. The mortality rate ranges from 0.1-1.1 cases per 1000 procedures and 1/30 women will experience a major adverse event. Risks include those usually associated with major surgery.

• #4 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Surgical management has been the standard of treatment in menorrhagia due to structural causes (eg, fibroids) or when medical therapy fails to alleviate symptoms. Surgical treatment ranges from a simple DC to a total hysterectomy. […] Surgical management is based on the acuity and severity of bleeding, contraindications and response to medical management, and the underlying etiology of bleeding. Choosing a surgical modality is a shared decision-making process, which depends on the previously mentioned considerations, future fertility, and the patients goals. […] A DC should be used for diagnostic purposes. It is not used for treatment because it provides only short-term relief, typically 1-2 months, though can be used to stop acute bleeding episodes in specific circumstances. […] Endometrial ablation is a surgical procedure that destroys the endometrium. For many, this procedure provides a minimally invasive and effective option for menorrhagia and can be used for acute uterine bleeding. Ablation is typically considered if a patient has failed medical therapy or desires more definitive management, and/or other options are contraindicated.

• #5 Adolescent gynaecology – Heavy menstrual bleeding

  https://www.rch.org.au/clinicalguide/guideline_index/adolescent_gynaecology_menorrhagia/

  The most common cause of Heavy Menstrual Bleeding (HMB) in adolescents is anovulatory cycles. […] Mild bleeding with a normal haemoglobin can be managed with reassurance, non-hormonal treatments and observation. […] Hormonal therapy aims to stabilise the endometrium. […] Treatment is targeted to the underlying cause; for anovulatory bleeding, the objective is to stabilise the endometrium (oestrogen for initial haemostasis and progestins for extended endometrial stability). […] Consider non-hormonal management such as regular NSAIDs and tranexamic acid during menses. […] Hormonal Therapy: Combination estrogen-progesterone oral contraceptive pills can decrease flow by 50% and is effective for anovulation or irregular menses. […] All patients may benefit from iron supplements. […] Tranexamic acid taken day 15 of menses can decrease flow by 25-50%. […] All NSAIDs can decrease flow if taken regularly during menstruation. […] Progestins generate a secretory endometrium and are good for anovulation (infrequent periods) due to the lack of progesterone.

• #5 Mirena® (levonorgestrel-releasing intrauterine system) 52mg

  https://www.mirena-us.com/heavy-period-treatment

  Mirena is FDA-approved to treat heavy periods for up to 5 years in women who choose an IUD for birth control. […] Mirena IUD prevents pregnancy for up to 8 years, and also treats heavy periods for up to 5 years in women who choose an IUD for birth control. […] Mirena is highly effective at reducing heavy periods. […] In a clinical trial performed in women with heavy menstrual bleeding that were treated with Mirena, almost 9 out of 10 were treated successfully — with their blood loss reduced by more than half after 6 months. […] Mirena can reduce heavy periods for up to 5 years in women who chose an IUD for birth control. […] Bleeding and spotting may increase in the first 3 to 6 months and remain irregular. Periods over time usually become shorter, lighter, or may stop.

• #5 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Progestin is the most frequently prescribed medication for menorrhagia likely because of its safety in the setting of other medical comorbidities and its efficacy. Therapy with this drug results in a significant reduction in menstrual blood flow when used alone. Progestin works as an antiestrogen by minimizing the effects of estrogen on target cells, thereby maintaining the endometrium in a state of nonproliferation. Common adverse effects include weight gain, headaches, edema, and depression. […] High-dose oral progestin options (eg, norethindrone 5-15 mg daily, medroxyprogesterone 5-30 mg daily) can be taken day 5 to 26 of the menstrual cycle or continuously and have shown to reduce blood loss by 80%. In contrast to the combined OCPs, low-dose progestin-only pills (POPs) (eg, 0.35 mg norethindrone) typically for contraceptive use are not usually recommended for treatment of menorrhagia as they are associated with irregular and unpredictable blood loss.

• #5 Managing Menorrhagia

  https://www.uspharmacist.com/article/managing-menorrhagia

  The levonorgestrel intrauterine system (LNG-IUS), commonly used as a contraceptive, has shown significant benefit over oral progestogens that are given over days 5 to 26 in the reduction of menstrual blood loss. […] Danazol works by suppressing the pituitary-ovarian axis and inhibiting the pituitary output of gonadotropins, hormones that increase in the endometrium. […] As a last resort, women suffering from menorrhagia may opt for surgical procedures. […] Hysterectomy is perhaps the most definitive treatment for menorrhagia, but it can be quite costly. […] Endometrial ablation is less invasive and more cost-effective, achieving patient satisfaction rates of about 90% and amenorrhea in about 50% of patients. […] With the wide range of effective hormonal and nonhormonal treatment options available on the market, health care professionals, including pharmacists, are in a position to successfully manage menorrhagia.

• #6 Heavy menstrual bleeding – Wikipedia

  https://en.wikipedia.org/wiki/Heavy_menstrual_bleeding

  Tranexamic acid treatments, which reduce bleeding by inhibiting the clot-dissolving enzymes, appear to be more effective than anti-inflammatory treatment like NSAIDs, but are less effective than LNG-IUS. Tranexamic acid tablets may reduce loss by up to 50%. […] NSAIDs are also used to reduce heavy menstrual bleeding by an average of 20-46% through inhibiting the production of prostaglandins. […] In the UK, NICE guidelines say that for individuals with HMB and no identified pathology or fibroids less than 3 cm in diameter who do not wish to have pharmacological treatment and who do not want to conserve their fertility, surgical options could be considered as a first-line treatment option. Options include a hysterectomy and second generation endometrial ablation, with hysterectomy being more effective than second generation endometrial ablation.

• #6 Mirena® (levonorgestrel-releasing intrauterine system) 52mg

  https://www.mirena-us.com/heavy-period-treatment

  Mirena is FDA-approved to treat heavy periods for up to 5 years in women who choose an IUD for birth control. […] Mirena IUD prevents pregnancy for up to 8 years, and also treats heavy periods for up to 5 years in women who choose an IUD for birth control. […] Mirena is highly effective at reducing heavy periods. […] In a clinical trial performed in women with heavy menstrual bleeding that were treated with Mirena, almost 9 out of 10 were treated successfully — with their blood loss reduced by more than half after 6 months. […] Mirena can reduce heavy periods for up to 5 years in women who chose an IUD for birth control. […] Bleeding and spotting may increase in the first 3 to 6 months and remain irregular. Periods over time usually become shorter, lighter, or may stop.

• #7 Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3430088/

  This review evaluates the use of tranexamic acid in the management of regular HMB in terms of efficacy, tolerability, dosage, and cost. […] Compared with the baseline, tranexamic acid 1.54.5 g/day taken for 47 days per cycle reduced mean MBL by 26%60% (P 0.05). […] In comparison with placebo, tranexamic acid reduced mean MBL from the baseline by 26%50%, while a 2%8% reduction was seen in the placebo groups (P 0.05). […] Treatment of heavy menstrual bleeding with tranexamic acid had no effect on duration of bleeding in most studies. […] The majority of treatment studies comparing tranexamic acid with either placebo or other medical therapies have used a tranexamic acid dosage of 44.5 g/day. […] Tranexamic acid 3.94 g/day for 45 days is an effective treatment for HMB. It significantly improves QOL relative to placebo or norethisterone, and is significantly more effective in reducing MBL than placebo, NSAIDs, oral cyclical luteal phase progestins, or etamsylate. […] Tranexamic acid is well tolerated and has a favorable safety profile. Adverse effects are few and they are mainly mild to moderate. […] Treatment of HMB with tranexamic acid seems cost-effective compared with no treatment or NSAIDs, but not when compared with LNG-IUS.

• #7 Treatment of Menorrhagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0615/p1813.html

  Menorrhagia is defined as excessive uterine bleeding occurring at regular intervals or prolonged uterine bleeding lasting more than seven days. […] The levonorgestrel-releasing intrauterine device is an effective therapy for women who want to preserve fertility and avoid surgery. […] Overall, hysterectomy and endometrial ablation result in the greatest satisfaction rates if future childbearing is not desired. Treatment of menorrhagia results in substantial improvement in quality of life. […] Oral progestogens are the most commonly prescribed therapy for menorrhagia. […] Oral progestin therapy for 21 continuous days (days 5 to 26 of the menstrual cycle) effectively reduces menstrual blood loss, but patient satisfaction is higher with the levonorgestrel-releasing IUD. […] Although used as a contraceptive, the levonorgestrel-releasing IUD produces significant reductions in menstrual blood loss.

• #8 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Tranexamic acid (Lysteda) was the first nonhormonal product approved by the FDA (in November of 2009) for the treatment of heavy menstrual bleeding. It is a synthetic derivative of lysine that uses antifibrinolytic effects by inhibiting the activation of plasminogen to plasmin. Tranexamic acids mechanism of action in treating heavy menstrual bleeding is by prevention of fibrinolysis and the breakdown of clots via inhibiting endometrial plasminogen activator. Most recommend using oral or IV tranexamic acid. Oral tranexamic is commonly given as 1.3 g tablets three times per day for the first 5 days of menses. Tranexamic acid has been shown to reduce bleeding by 30-55% in those with chronic AUB. In a double-blind, placebo-controlled study, women taking 3.9 g/d of tranexamic acid showed a significant reduction in menstrual blood loss and an increase in their health-related quality of life compared with those taking placebo. Common adverse effects include menstrual discomfort, headache, and back pain.

• #8 Heavy Periods – WHRIA

  https://www.whria.com.au/for-patients/gynaecology/heavy-periods/

  If you have heavy periods, you should see a doctor so that your medical history can be recorded and an examination can be performed. […] There is a range of treatment options, and the best one for you will depend on your age and reproductive needs. The good news is that in most cases a surgical approach can be avoided. […] Tranexamic acid helps stop blood clots from breaking up within the womb and therefore reduces the amount of blood lost during a period. […] These include Ponstan and Naprogesic and are best known for helping to relieve period pain. However, if a full dose is taken continuously for the first five days of menstruation, they can reduce blood loss by around 25%. […] Taking the Pill is an effective method of birth control and can reduce menstrual blood loss by 30-50%.

• #9

  https://www2.hse.ie/conditions/heavy-periods/treatment/

  There are many options available to treat heavy periods. […] Your treatment options depend on: your symptoms, your general health, what is causing your heavy periods, if you’re trying to get pregnant or want to in the future, your personal preferences. […] Discuss the benefits and risks of the different options with your doctor. Some treatments may have an impact on your future fertility. […] There are medicines that do not contain hormones that can help you manage heavy periods. […] Your GP may prescribe tranexamic acid if: an IUS is unsuitable, you’re waiting for more tests or another treatment. […] You take tranexamic acid as tablets. It works by helping the blood in your womb to clot. […] Tranexamic acid tablets are usually taken 3 times a day for 4 days. You start taking the tablets as soon as your period starts.

• #9 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medical therapy in ovulatory menorrhagia. Studies show an average reduction of 20-46% in menstrual blood flow. NSAIDs reduce prostaglandin levels by inhibiting cyclooxygenase and decreasing the ratio of prostacyclin to thromboxane. NSAIDs are often ingested for the first 5 days of a menstrual cycle, although the use is limited by the most common adverse effect of stomach upset. NSAIDs should be avoided in patients with an allergy or with peptic ulcer and renal disease. […] Oral contraceptive pills (OCPs) are a popular first-line therapy for women who desire contraception in addition to management of abnormal uterine bleeding (AUB). Menstrual blood loss is reduced as effectively as NSAIDs secondary to endometrial atrophy. OCPs suppress pituitary gonadotropin release and thus ovulation. OCPs can be used in continuous or extended fashion for menorrhagia and multidose regimens for acute AUB. Common adverse effects include breast tenderness, breakthrough bleeding, nausea, and related weight gain in some individuals. The vaginal ring and transdermal patch require less frequent administration than daily OCPs. Both the ring and patch can be used similarly to OCPs, with a standard 28-day cycle, extended cycles, or continuously. Patients should be counseled about the various routes of administration for combined contraceptives and the benefits and disadvantages of each.

• #10

  https://vajenda.substack.com/p/treatment-of-heavy-menstrual-bleeding

  Heavy menstrual bleeding is often under-treated, and consequently, many suffer not only from the hassle of heavy bleeding but also from health consequences due to the resulting anemia and/or iron deficiency. […] Whether someone has been diagnosed with iron deficiency or simply has heavy periods that are bothersome, there are a variety of therapies that can reduce menstrual blood loss. Hormones, like the birth control pill, a hormone IUD, or the Nexplanon implant, are all great options. […] There is also another on-demand medication, tranexamic acid, which I think is under-prescribed, at least in the United States. Its a good option because A) it works, and B) it is an option for people who cant or don’t want to take hormones or NSAIDs or when these options dont work. […] Tranexamic acid is taken three times a day during menstruation (the dose in the United States is 1.3 g orally three times a day for up to five days, but the dose can vary a little by country). In studies, it reduces menstrual blood loss by up to 50% compared with placebo.

• #10 Patient education: Heavy periods (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/heavy-periods-beyond-the-basics/print

  If you have heavy menstrual bleeding, the best treatment for you will depend on: the cause of your bleeding, your preferences, whether you want to prevent pregnancy, whether you might want to be able to get pregnant in the future. Your health care provider will probably recommend treatment with one or more medicines first. If these treatments do not reduce bleeding enough, surgical treatment might be an option. […] Hormonal birth control — If you have heavy menstrual bleeding and do not want to get pregnant right now, hormonal birth control might be a good option. Options include the pill, skin patch, vaginal ring, shot, and hormonal intrauterine device (IUD). These treatments reduce uterine bleeding. Hormonal birth control can also reduce cramps and pain when you have bleeding. It might take three months for bleeding to improve after you start taking hormonal birth control.

• #11 Menorrhagia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/255540-treatment

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medical therapy in ovulatory menorrhagia. Studies show an average reduction of 20-46% in menstrual blood flow. NSAIDs reduce prostaglandin levels by inhibiting cyclooxygenase and decreasing the ratio of prostacyclin to thromboxane. NSAIDs are often ingested for the first 5 days of a menstrual cycle, although the use is limited by the most common adverse effect of stomach upset. NSAIDs should be avoided in patients with an allergy or with peptic ulcer and renal disease. […] Oral contraceptive pills (OCPs) are a popular first-line therapy for women who desire contraception in addition to management of abnormal uterine bleeding (AUB). Menstrual blood loss is reduced as effectively as NSAIDs secondary to endometrial atrophy. OCPs suppress pituitary gonadotropin release and thus ovulation. OCPs can be used in continuous or extended fashion for menorrhagia and multidose regimens for acute AUB. Common adverse effects include breast tenderness, breakthrough bleeding, nausea, and related weight gain in some individuals. The vaginal ring and transdermal patch require less frequent administration than daily OCPs. Both the ring and patch can be used similarly to OCPs, with a standard 28-day cycle, extended cycles, or continuously. Patients should be counseled about the various routes of administration for combined contraceptives and the benefits and disadvantages of each.

• #12 Causes and treatment of heavy menstrual bleeding – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/causes-and-treatment-of-heavy-menstrual-bleeding/

  Hormonal choices are more common: estrogen and progesterone combined in pill form, vaginal ring or a patch. […] When using the combined oral contraceptive pill, we recommend that you use at least a 30 microgram ethinyl estradiol and a monophasic pill, Dr. Huhmann said, offering Sprintec and Junel as examples with the monthly cycle or Seasonique every three months. […] Progesterone-only options include: Medroxyprogesterone (Provera), which is not a contraceptive, at 10 to 20 milligrams daily; Norethindrone acetate (Aygestin), which is not a contraceptive, at 5 to 10 milligrams daily. […] For patients who need contraception, but want to use a progesterone-only pill, 0.35 milligrams norethindrone (Micronor) or 4 milligrams drospirenone (Slynd) are options. […] Other options for contraception and menstrual regulation include medroxyprogesterone acetate (Depo-Provera), the Nexplanon etonogestrel implant or the levonorgestrel intrauterine device. […] The Nexplanon is associated with more irregular breakthrough bleeding that you’ll want to discuss with your patients, Dr. Huhmann said. You also may need to supplement with the progesterone-only pill with that implant in order to get better menstrual suppression.

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