Medical treatment for havy menstrual bleeding

General Guidelines


Drug therapy can be very useful for many women with menorrhagia 

Women should feel confident that they understand all of their options and exercise their own treatment preferences. 

A general drug treatment regimen for menorrhagia is as follows: 

NONHORMONAL AGENTS.

The use of nonhormonal agents is an appropriate first choice when the menstrual cycle is regular. 

  • The first options are nonsteroidal anti-inflammatory drugs, with reported reductions in menstrual blood loss of 25% to 35%. 
  • Tranexamic acid is a drug that enhances blood clotting and is used more in Europe than in the US. It is proving to be very effective, and women might ask their physician if it is available.


HORMONAL AGENTS.

Hormonal agents are useful for women with heavy bleeding who also want to control the menstrual cycle. 


  • The best choice for women who also want effective birth control is either the combined oral contraceptive pill or a progestin containing intrauterine device
  • The levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena, FibroPlant) specifically is proving to be a particularly effective treatment for menorrhagia. 
  • Danazol and the gonadotropin-releasing hormone (GnRH) analogues are highly effective for more severe cases, but their side effects make them suitable only for short-term use. These agents are also useful as pretreatment before procedures used to destroy the uterine lining. Both are effective, but GnRH analogues may be slightly better.