Question: Can Hormonal Contraceptives Be Part of a Menorrhagia Treatment Plan?
Menorrhagia is heavy menstrual bleeding and can lead to iron deficiency anemia if left untreated. It has been estimated to occur in about 10% of women of reproductive age, although as many as 30% of women will seek treatment for this condition.
Contraceptives that reduce overall bleeding episodes may be especially helpful in the management of menorrhagia. These birth control methods can be a reversible menorrhagia treatment (with less serious side effects) as opposed to the alternative menorrhagia treatment, a surgical procedure called endometrial ablation, which leads to sterilization.
The Pill is one of the most widely used birth control methods. Women choose the Pill, as well as other hormonal contraceptives, due to its high effectiveness and ease of use. Yet many users may not be aware of some of the noncontraceptive benefits of hormonal contraception. In fact, certain hormonal contraceptives can be part of a menorrhagia treatment plan.
Given that every women may have different reactions to specific birth control methods, this information is intended as a general overview. The main reason to use hormonal birth control is for contraception (to prevent an unintended pregnancy) -- however, possible noncontraceptive benefits can be considered when determining which hormonal contraceptive to ultimately use.
The following is a list of specific prescription birth control methods that have been shown to be effective in providing some help for menorrhagia:
- Combined Hormonal Contraceptives: These birth control methods contain both a progestin and synthetic estrogen. Combination birth control can reduce heavy menstrual bleeding in most affected women and are considered a reasonable option for initial menorrhagia treatment/management. This may be an especially good treatment option for women who may desire future fertility because the contraceptive effect is readily reversible.
- Combination Birth Control Pills: Menstrual blood loss can be reduced by 40 to 50% in women who use combination birth control pills. Additionally, research has also shown that triphasic combination pills (oral contraceptives that have changing levels of estrogen and progestin to more closely mimic the hormonal phases during a woman’s menstrual cycle) have been especially successful at reducing the menstrual blood loss associated with menorrhagia.
- Extended Cycle Birth Control Pills: Continuous birth control pills (like Lybrel or Seasonique) typically reduce overall bleeding episodes, so they may be especially helpful in the management of menorrhagia. Also, using regular birth control pills to skip your period may also provide some relief.
- Progestin-Only Contraceptives: These hormonal contraceptives are a good alternative for women who wish to use hormonal birth control but may not be able to choose a method due to estrogen intolerance. Progestin-only contraceptive options can help reduce overall bleeding days during menstruation and may allow some women to not have a period at all. Because of this, these methods may be a possible part of a menorrhagia treatment plan.
Mirena IUD: The progestin-only Mirena IUD was found to show reductions in menstrual blood loss and improvement in quality of life comparable to endometrial ablation, but with less serious side effects. Research indicates up to an 86% reduction in blood loss after three months of Mirena use and up to 97% after 12 months. Mirena also allows for future fertility (whereas a women can no longer have children after obtaining endometrial ablation).
Compared to women who used progestin-only pills (with the progestin norethindrone), those who used the Mirena IUD for menorrhagia treatment appear to be are more satisfied and willing to continue with treatment, and studies show that Mirena may be a more effective option than these birth control pills.
Barrington JW, Bowen-Simpkins P. "The levonorgestrel intrauterine system in the management of menorrhagia." Br J Obstet Gynaecol 1997;104:614–6. Accessed via private subscription.
Cedars MI. "Triphasic oral contraceptives: Review and comparison of various regimens." Fertil Steril 2002;77:1–14. Accessed via private subscription.
Fraser IS, McCarron G. "Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia." Aust N Z J Obstet Gynaecol 1991;31:66–70. Accessed via private subscription.
Istre O, Trolle B. "Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection." Fertil Steril 2001;76:304–9. Accessed via private subscription.
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. "Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: A systematic review and meta-analysis." Obstet Gynecol 2009;113:1104–16. Accessed via private subscription.
Larsson G, Milsom I, Lindstedt G, Rybo G. "The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status." Contraception 1992;46:327–34. Accessed via private subscription.
Sulak PJ, Carl J, Gopalakrishnan I, Coffee A, Kuehl TJ. "Outcomes of extended oral contraceptive regimens with a shortened hormone-free interval to manage breakthrough bleeding." Contraception 2004;70:281–7. Accessed via private subscription.