Heavy menstrual bleeding
Menstrual blood loss exceeding 80 mL per cycle with quality-of-life impact. Treatment — levonorgestrel IUS, COCs, tranexamic acid, NSAIDs, surgical interventions.
ICD-10 N92.03 drugs
Also known as: Menorrhagia, HMB
Drugs used for this condition
- AEstradiol valerate + DienogestFirst line · COC with natural estrogen (quadriphasic)Heavy menstrual bleeding in women without organic pathology (fibroids, adenomyosis, polyps). PRO-MENS RCT 2014 showed 88% reduction in menstrual blood loss vs placebo. Per NICE NG88 2018 and SEGO 2023, drug of choice in women who also need contraception. Alternative – LNG-IUS (Mirena) with up to 90% blood loss reduction.
- ALevonorgestrel (intrauterine system)First line · Long-acting intrauterine hormonal system (LARC)Heavy menstrual bleeding (Mirena 52 mg). Per NICE NG88 2018 and SEGO 2023, first-line. 70–90% blood loss reduction by month 6. Effective alternative to hysterectomy and endometrial ablation in women with preserved reproductive function.
- ATranexamic acidFirst line · Antifibrinolytics, amino acidsPer NICE NG88 and ACOG 2024, tranexamic acid is first-line pharmacotherapy for heavy menstrual bleeding without organic pathology. Oral 1 g three to four times daily during the first 3–5 days of menses. Reduces menstrual blood loss by 40–50 %. Effect only during dosing – does not regulate cycles or provide contraception.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit