Advantages | Disadvantages | |
COCs |
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LNG 52 mg IUD (Mirena or Liletta) |
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TXA |
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NSAIDs |
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For patients with HMB and no known structural, infectious, or endocrine etiology, initial treatment options include COCs, LNG 52 mg IUD, TXA, and NSAIDs. The choice of therapy depends on several factors (eg, bleeding severity, patient preferences, comorbidities, need for contraception). For patients who cannot or choose not to use one of these methods, reasonable alternatives include other progestin-therapies (eg, oral progestins, DMPA) and noncontraceptive doses of estrogen-progestin; surgical interventions (eg, endometrial ablation, hysterectomy) are also options for patients who have completed childbearing. These options are discussed in related UpToDate content.
Some therapies (eg, COCs or LNG 52 IUD plus NSAIDs) may be used concurrently.COCs: combination oral contraceptives; DMPA: depot medroxyprogesterone acetate; HMB: heavy menstrual bleeding; LNG 52 mg IUD: 52 mg levonorgestrel-releasing intrauterine device; NSAIDs: nonsteroidal anti-inflammatory drugs; TXA: tranexamic acid; VTE: venous thromboembolism.
* Some experts consider concomitant use of TXA and COCs to be reasonable in patients with a bleeding disorder (eg, von Willebrand disease), or those in whom additional thrombosis risk factors (eg, obesity, immobility) are not present.