Specific treatment for menorrhagia is based on a number of factors, including:
- Your overall health and medical history
- The cause and severity of the condition
- Your tolerance for specific medications, procedures or therapies
- The likelihood that your periods will become less heavy soon
- Your future childbearing plans
- Effects of the condition on your lifestyle
- Your opinion or personal preference
Drug therapy for menorrhagia may include:
- Iron supplements. If you also have anemia, your doctor may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve), help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
- Tranexamic acid. Tranexamic acid (Lysteda) helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.
- Oral contraceptives. Aside from providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
- Oral progesterone. When taken for 10 or more days of each menstrual cycle, the hormone progesterone can help correct hormone imbalance and reduce menorrhagia.
- The hormonal IUD (Mirena). This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the condition by changing or stopping your medication.
You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include:
- Dilation and curettage (D&C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats acute or active bleeding successfully, you may need additional D&C procedures if menorrhagia recurs.
Uterine artery embolization. For women whose menorrhagia is caused by fibroids, the goal of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply.
During uterine artery embolization, the surgeon passes a catheter through the large artery in the thigh (femoral artery) and guides it to your uterine arteries, where the blood vessel is injected with microspheres made of plastic.
- Focused ultrasound ablation. Similar to uterine artery embolization, focused ultrasound ablation treats bleeding caused by fibroids by shrinking the fibroids. This procedure uses ultrasound waves to destroy the fibroid tissue. There are no incisions required for this procedure.
- Myomectomy. This procedure involves surgical removal of uterine fibroids. Depending on the size, number and location of the fibroids, your surgeon may choose to perform the myomectomy using open abdominal surgery, through several small incisions (laparoscopically), or through the vagina and cervix (hysteroscopically).
- Endometrial ablation. Using a variety of techniques, your doctor permanently destroys the lining of your uterus (endometrium). After endometrial ablation, most women have much lighter periods. Pregnancy after endometrial ablation can put your health at risk — if you have an endometrial ablation, you should use reliable or permanent contraception until menopause.
- Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Pregnancy isn't recommended after this procedure.
- Hysterectomy. Hysterectomy — surgery to remove your uterus and cervix — is a permanent procedure that causes sterility and ends menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause.
Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you may need a general anesthetic, it's likely that you can go home later on the same day.
When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in lighter periods.
July 02, 2014
- Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed April 6, 2014.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed April 6, 2014.
- Bano R, et al. Heavy menstrual bleeding. Obstetrics, Gynaecology and Reproductive Medicine. 2013;24:1.
- Pizzorno JE, et al. Textbook of Natural Medicine. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2013. https://www.clinicalkey.com. Accessed April 6, 2014.
- Adams JG. Emergency Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. https://www.clinicalkey.com. Accessed April 6, 2014.
- Zacur HA. Chronic menorrhagia or anovulatory uterine bleeding. http://www.uptodate.com/home. Accessed April 6, 2014.
- Laughlin-Tommaso SK (expert opinion). Mayo Clinic, Rochester, Minn. April 15, 2014.
- Hesley GK, et al. MR-Guided focused ultrasound for the treatment of uterine fibroids. CardioVascular and Interventional Radiology. 2013;36:5.
- De Silva NK. Abnormal uterine bleeding in adolescents: Definition and evaluation. http://www.uptodate.com/home. Accessed May 13, 2014.