Expert answer:
In cases of heavy menstruation, there are a few treatments which can be used to decrease menstrual flow, according to each case. Some options:
- Intravenous application of high doses of estrogen: They promote rapid growth of the endometrium (the innermost layer of the uterus). It is usually the initial treatment of choice for treating intense menstruation. Due to the risk of pulmonary embolism, only the minimum effective dose should be applied;
- Uterine curing (scraping or suctioning of the uterus): It effectively ends with severe bleeding and is the only surgical option for women who still want to have children. However, it does not treat the cause of heavy menstruation, which will happen again if another therapy is not started;
- Packing: It can be done by placing within the uterine cavity a specific catheter containing a flask which is filled with 10 to 30 ml of liquid. Three hours later, half of this liquid is removed, and as long as there is no further bleeding for one hour, the probe can be removed. If the bleeding persists or is very intense, the balloon can be maintained for 12 hours;
- Hysterectomy: If all other methods fail, one may opt for hysterectomy (surgery to remove the uterus);
- Oral estrogens in high doses: Indicated for stable patients who can tolerate oral therapy without stomach problems;
- High-dose oral contraceptives: High doses of combined oral contraceptives usually stop the bleeding in 48 hours. It is contraindicated for smokers because of the risk of venous thrombosis;
- Antifibrinolytic drugs: They work within two to three hours after administration, do not interfere with fertility and may be more effective than non-steroidal anti-inflammatory drugs (NSAIDs);
- Endometrial ablation: It is an effective treatment for heavy menstruation (acute bleeding), but it is not recommended for women who want to become pregnant because it consists of definitive destruction of the endometrium.
In case of heavy menstruation, the woman should seek a gynecologist, which should indicate the best treatment, according to the case.
