4 - Medical management of excessive menstrual bleeding

Summary

Management of excessive menstrual bleeding has changed over the past two decades with the promotion of effective medical treatments and in particular the use of the levonorgestrel-releasing intrauterine device. The aims of therapy are to reduce blood loss, reduce the risk of anaemia and improve quality of life. Non-hormonal treatment options for excessive menstrual bleeding are non-steroidal anti-inflammatory drugs, antifibrinolytics, and etamsylate. Intrauterine administration of levonorgestrel, oral and intramuscular progestogens, oestrogen/progestogen combinations, and antiprogestogens are used as hormonal treatments for excessive menstrual bleeding. Plasminogen activator inhibitors have been promoted as a treatment for excessive menstrual bleeding because of increased endometrial fibrinolytic activity in women. The use of progestogens is based on the erroneous concept that women with excessive menstrual bleeding principally have anovulatory cycles and require progestogen supplementation. From clinical experience, combined oral contraceptives (COCs) are generally considered to be effective in the management of dysfunctional menstrual bleeding.