Medicines often help treat abnormal uterine bleeding, and they have fewer risks than surgical treatment. If you plan to become pregnant in the future, or if you are nearing the time when your menstrual periods will stop (menopause), you may want to try medicines first.
Goals of medicine treatment
The goal of medicine treatment for abnormal uterine bleeding is to reduce or eliminate blood loss. This can be done in one or both of the following ways:
- Reducing the endometrium's rate of blood loss
- Regulating or eliminating the menstrual cycle by changing hormonal levels
There are several hormone therapies for managing abnormal uterine bleeding. These treatments help reduce bleeding and regulate the menstrual cycle:
- Birth control pills (synthetic estrogen and progesterone). Daily birth control pills prevent pregnancy. They also reduce the amount of heavy menstrual bleeding by about half.2 In other words, when you take birth control pills, your menstrual bleeding can be half as heavy as it was before you took the pills. But when you stop taking the pills, irregular bleeding or perimenopausal symptoms may return.
- Progestin pills (synthetic progesterone). In some women, progestins can control endometrial growth and bleeding. You usually take progestins 10 to 12 days every month.
- The levonorgestrel intrauterine device (IUD). A doctor inserts this birth control device into your uterus through your vagina. It stays in your body for up to 5 years and releases levonorgestrel, a form of progesterone, into the uterus.
- Estrogen. In some severe or urgent cases, estrogen may be used to reduce bleeding.
- Hormone suppressors such as gonadotropin-releasing hormone analogues (GnRH-As). GnRH-As are rarely used. These drugs reduce estrogen production, making your body think it is in menopause. This reduces or stops menstrual periods for as long as you take the medicine. Side effects with GnRH-As are common.
A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.
What to think about
Intravenous estrogen therapy is typically used when severe blood loss must be quickly stopped.