Abnormal menstrual bleeding, also called abnormal uterine bleeding, is one of the most common reasons for visits to the gynecologist. In my previous post, I reviewed the most common causes of abnormal bleeding. Depending on the cause, there are several treatment options. For many patients, the first option we’ll try for treating abnormal bleeding is medication.

Managing Abnormal Menstrual Bleeding With Birth Control Pills

The most common medical treatment option for abnormal bleeding is birth control pills. Birth control pills are often tried first because they are safe, inexpensive and will work for most people with abnormal bleeding. Many patients find that, in addition to reducing the amount of menstrual flow, their cycles become regular with birth control pills. Birth control pills may offer other medical advantages, like correcting anemia and reducing premenstrual symptoms, in addition to preventing conception. Side effects are few, but talk to your provider about any that you experience.

There are a few reasons we wouldn’t prescribe birth control pills. If you smoke and are over 35, then you are not a good candidate for them. Also, if you have a clotting disorder or certain types of migraine headaches, then you may not be a good candidate for birth control pills. If you still have abnormal bleeding after trying birth control pills for 2-3 months, your provider may perform further tests, such as an ultrasound to evaluate for any anatomic abnormalities, such as fibroids or polyps.

Managing Abnormal Menstrual Bleeding with a Hormonal IUD

The levonorgestrol intrauterine device (LNG-IUD), marketed as the Mirena IUD, is also an excellent way to control heavy menstrual bleeding. Most women will experience a significant decrease in menstrual bleeding within the first six months with Mirena. It is not uncommon for some women to stop having their periods entirely after 6-12 months of use. This is because the IUD releases a small amount of progestin that thins the lining of the uterus. This does not pose any problems for women interested in future pregnancy after IUD use. Other advantages include few side effects, not having to take a pill every day and being one of the most reliable forms of reversible contraception available. An LNG-containing IUD can also be used to treat heavy, prolonged menstrual bleeding. In research studies, they are just as effective as the surgical option of endometrial ablation. They can also be used to help prevent conditions that may lead to precancerous conditions of the uterus.

IUDs are very safe and can be used by most women, even if you have never had a child. If you have fibroids or a congenital condition that distorts the inside of the uterus, IUDs may not be for you.

Managing Abnormal Bleeding With Progesterone-Only Pills

Progesterone-only pills are another method used to control abnormal bleeding. This option is often not as effective as birth control pills or the LNG-IUD, but may be a very good alternative if you cannot take or tolerate estrogen. These will often be used for 10 to 14 days during the month or on a daily basis.

Managing Abnormal Bleeding With Tranexamic Acid (Lysteda)

Tranexamic acid, marketed as Lysteda, has been used around the world for a number of years and was approved by the FDA in 2010 for the treatment of heavy menstrual cycles. It is a non-hormonal medication to help decrease heavy periods. It is taken for 3-5 days during your period and has been shown to decrease the amount of menstrual bleeding. Not everyone is a good candidate for this medication and you should discuss this with your provider. If you have any risk factors for blood clots you should not take this medication.

Though it is cost-effective with few side effects, medication is not the only option for treating abnormal menstrual bleeding. In my next post, I’ll go over the surgical options you may want to consider with your provider.