How is menorrhagia treated?

Updated: Dec 20, 2018
  • Author: Julia A Shaw, MD, MBA, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Answer

Medical therapy should be tailored to characteristics of the patient (eg, age, coexisting medical diseases, family history, and desire for fertility). Agents used include the following:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): First-line medical therapy for ovulatory menorrhagia

  • Oral contraceptive pills (OCPs): A popular first-line therapy for women who desire contraception; dienogest−estradiol valerate has been approved by the US Food and Drug Administration (FDA) for heavy menstrual bleeding

  • Progestin: The most frequently prescribed medicine for menorrhagia

  • Levonorgestrel intrauterine system: Approved by the FDA for treatment of menorrhagia in women who use intrauterine conception; a 2-year primary care–based study of 571 women aged 25-50 years (mean, 42 years) found that a levonorgestrel intrauterine system was more effective than usual medical treatments in alleviating the adverse effects of menorrhagia on women’s lives [1, 2] ; although some fault the study for failing to adequately eliminate other possible causes of excessive bleeding before initiating treatment, the finding that 90% of the women were aged 35 years or older suggests that for the majority of the patients studied, the heavy bleeding was probably a result of age-related ovarian dysfunction [1]

  • Gonadotropin-releasing hormone (GnRH) agonists

  • Danazol

  • Conjugated estrogens

  • Tranexamic acid


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