Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Jan;12(1):27-34.
doi: 10.2217/whe.15.100. Epub 2015 Dec 23.

Medical management of heavy menstrual bleeding

Jacqueline A Maybin  1 , Hilary O D Critchley  1
Affiliations
Review

Medical management of heavy menstrual bleeding

Jacqueline A Maybin et al. Womens Health (Lond). 2016 Jan.

Abstract

Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life. The role of the clinician is to provide information to facilitate women in making an appropriate choice. Unfortunately, many options can be associated with hormonal side effects, prevention of fertility and lack of efficacy, leading to discontinuation and progression to surgical interventions. Herein, we discuss the various options currently available to women, including antifibrinolytics, nonsteroidal anti-inflammatory preparations, oral contraceptive pills and oral, injectable and intrauterine progestogens. In addition, we describe the more novel option of selective progesterone receptor modulators and their current benefits and limitations.

Keywords: SPRM; adenomyosis; endometrial; endometrium; estradiol; fibroid; menorrhagia; menstruation; polyps; progesterone.

PubMed Disclaimer

Conflict of interest statement

Financial & competing interests disclosure HOD Critchley has received collaborative Research Grant Support for research staff and consumables in context of AUB treatment from TAP Pharmaceuticals and Bayer Pharma AG; and provided Consultancy/Advisory Board contributions on AUB Treatment (Bayer Pharma AG, Preglem/Gedeon-Richter, Vifor Pharma). HOD Critchley and JA Maybin have received research grant support from the Medical Research Council (G1002033 (HODC, JAM), MR/J003611/1 (HODC) and The Wellcome Trust (100646/Z/12/Z [JAM]). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. The fibrinolytic pathway.
PA: Platelet activator; PAI: Platelet activator inhibitor.
<b>Figure 2.</b>
Figure 2.. Synthesis and signalling of prostaglandins.
PG: Prostaglandin; PGI: Prostacyclin; TXA: Thromboxane.
<b>Figure 3.</b>
Figure 3.. Impact of levonorgestrel-releasing intrauterine system on bleeding and spotting in the first year of use.
Reproduced with permission from [12] © Elsevier (1994).
<b>Figure 4.</b>
Figure 4.. x-ray confirming levonorgestrel intrauterine system perforation at time of insertion.
See this image and copyright information in PMC

References

    1. RCOG. Abdominal Hysterectomy for Benign Conditions. 2009. www.rcog.org.uk/globalassets/documents/guidelines/consent-advice/ca4-150...
    1. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int. J. Gynaecol. Obstet. 2011;113(1):3–13. - PubMed
    1. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstural abnormalities in women. Int. J. Obes. 1979;3(1):57–73. - PubMed
    1. Rowland AS, Baird DD, Long S, et al. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology. 2002;13(6):668–674. - PubMed
    1. Critchley HO, Duncan WC, Brito-Mutunayagam S, Reynolds RM. Obesity and menstrual disorders. In: Mahmood TA, Arulkumaran S, editors. Obesity: A Ticking Time Bomb for Fertility (Elsevier Insights) Elsevier; Oxford, UK: 2013. pp. 525–535.

Publication types

MeSH terms