Abnormal uterine bleeding (AUB) can significantly impact a person's quality of life, leading to discomfort, fatigue from anemia, and disruption of daily activities. While the specific cause of the bleeding will influence the best course of action, a variety of medications are available to manage and stop excessive flow. Treatments fall into non-hormonal and hormonal categories, each with a different mechanism of action and side effect profile.
Non-Hormonal Medications for Uterine Bleeding
Non-hormonal options are often preferred by individuals who do not wish to use hormonal contraception or have contraindications to hormonal therapy. These drugs focus on reducing bleeding by affecting the body's clotting and inflammatory processes.
Tranexamic Acid (Lysteda)
Tranexamic acid is an antifibrinolytic agent that works by stabilizing blood clots in the uterus, thereby reducing bleeding. It is typically taken orally for up to five days at the start of heavy bleeding during each menstrual cycle.
- How it works: In women with heavy menstrual bleeding, the breakdown of blood clots (fibrinolysis) is more active than normal. Tranexamic acid prevents this breakdown, allowing clots to remain stable and reducing blood loss.
- Effectiveness: Studies show that tranexamic acid can significantly reduce menstrual blood loss, with some reporting a reduction of 40% to 65%.
- Side effects and risks: Common side effects include headache, back pain, and sinus symptoms. A key contraindication is a history of thromboembolic disease (blood clots), as the medication can increase this risk.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs like ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) are commonly used to manage heavy bleeding, especially when accompanied by pain.
- How they work: High levels of prostaglandins can cause heavy menstrual bleeding. NSAIDs inhibit the enzymes (cyclooxygenase) that produce prostaglandins, helping to decrease menstrual blood flow.
- Effectiveness: NSAIDs can lead to a modest reduction in blood loss, averaging between 20% and 46%, and are particularly effective for those with ovulatory menorrhagia. However, they are less effective than tranexamic acid or hormonal IUDs.
- Side effects and risks: The most common side effects are gastrointestinal, such as stomach upset. They should be avoided by individuals with peptic ulcers or kidney disease. Unlike NSAIDs, aspirin is not recommended for heavy periods as it can increase bleeding.
Hormonal Medications for Uterine Bleeding
Hormonal therapies are a cornerstone of treatment for many types of uterine bleeding, particularly when contraception is also desired. They function by regulating the menstrual cycle and thinning the uterine lining.
Hormonal Contraceptives
Combination hormonal contraceptives, including birth control pills, patches, and vaginal rings, are a frequent first-line treatment for abnormal uterine bleeding.
- How they work: These products contain a combination of estrogen and progestin, which regulates the menstrual cycle and promotes a thinner uterine lining, leading to lighter and shorter periods. They can also be used continuously to stop periods altogether.
- Effectiveness: Birth control pills have been shown to significantly reduce menstrual flow and are an effective option for many women.
- Side effects and risks: Risks include an increased chance of blood clots, especially in women who smoke and are over 35. Other side effects can include nausea, breast tenderness, and headaches.
Hormonal Intrauterine Device (IUD)
The levonorgestrel-releasing intrauterine system (LNG-IUS), such as Mirena or Liletta, releases a small amount of progestin directly into the uterus over several years.
- How it works: The progestin thins the uterine lining, which dramatically reduces menstrual blood flow over time. Many users eventually stop having periods entirely.
- Effectiveness: The hormonal IUD is one of the most effective long-term medical treatments for heavy menstrual bleeding, often resulting in blood loss reduction of up to 97%.
- Side effects: Initial irregular bleeding or spotting is common. Other side effects can include acne, headaches, and breast tenderness, though these are often milder than with oral contraceptives due to localized hormone action.
Oral Progestin Therapy
For those who cannot take estrogen, oral progestin-only medications like norethindrone or medroxyprogesterone acetate can be used.
- How it works: Progestin minimizes the effects of estrogen on the uterine lining, keeping it from proliferating and causing excessive bleeding. It can be prescribed cyclically (days 5-26 of the cycle) or continuously to achieve amenorrhea (cessation of periods).
- Effectiveness: Can significantly reduce blood loss, but patient satisfaction may be lower than with an LNG-IUS. Continuous use is more effective at stopping bleeding than cyclic use.
- Side effects: Can cause weight gain, headaches, and mood swings.
Other Medical Treatments and Considerations
GnRH Agonists and Antagonists
Gonadotropin-releasing hormone (GnRH) agonists and antagonists temporarily induce a menopause-like state by suppressing the hormones that stimulate the ovaries.
- Usage: These are powerful medications used for short-term management, such as before a surgical procedure to shrink fibroids and control bleeding. They are not intended for long-term use due to side effects like bone mineral loss and menopausal symptoms.
- Newer options: Newer oral GnRH antagonists, sometimes used with hormone add-back therapy, offer a potential long-term option for fibroid-related bleeding.
Iron Supplements
If heavy uterine bleeding has led to iron deficiency anemia, iron supplements are a crucial part of the treatment plan to help correct low iron levels and alleviate symptoms like fatigue.
Comparison of Key Treatments for Heavy Uterine Bleeding
| Feature | Tranexamic Acid (Lysteda) | Hormonal IUD (e.g., Mirena) | Oral Contraceptives | NSAIDs (e.g., Ibuprofen) |
|---|---|---|---|---|
| Mechanism | Stabilizes blood clots | Releases progestin to thin uterine lining | Regulates hormones, thins lining | Inhibits prostaglandins |
| Hormonal | No | Yes (Progestin only) | Yes (Combined Estrogen/Progestin) | No |
| Duration | Used only during heavy bleeding (up to 5 days) | Long-term (up to 8 years) | Daily pill, patch, or ring | Used during heavy bleeding (first 5 days) |
| Contraception | No | Highly effective | Highly effective | No |
| Effectiveness | Significant reduction (~40-65%) | Highly effective, can cause amenorrhea | Effective reduction (~60%+) | Modest reduction (~20-46%) |
| Side Effects | GI issues, risk of clots | Initial spotting, acne, headaches | Nausea, breast tenderness, clot risk | GI issues, especially with prolonged use |
| Contraindications | History of thromboembolic disease | Uterine abnormalities | Smoking (>35), clot risk factors | Peptic ulcers, renal disease |
Conclusion
Deciding what medicine is used to stop uterine bleeding is a process that should be guided by a healthcare provider. The right treatment depends on a careful evaluation of the underlying cause of the bleeding, whether contraception is desired, and the patient's individual health profile. Non-hormonal options like tranexamic acid and NSAIDs offer a solution for those who want to avoid systemic hormones and primarily need relief during their menstrual cycle. For a more sustained and powerful effect, hormonal methods like the LNG-IUS or oral contraceptives are highly effective. For short-term management of specific conditions like fibroids, GnRH agonists or antagonists may be appropriate. Consulting a doctor is essential to ensure the safest and most effective choice for your specific situation. Early diagnosis and treatment can improve symptoms and quality of life.
