# Effectiveness of Medical Management in Heavy Menstrual Bleeding: A Prospective Cohort Study

## TL;DR

This study evaluates how well different medical treatments reduce heavy menstrual bleeding and improve hemoglobin levels in women.

## Contribution

The study provides comparative effectiveness data for various medical treatments of heavy menstrual bleeding in a real-world setting.

## Key findings

- All five medical treatments significantly reduced menstrual blood loss within three to six months.
- LNG-IUS showed the highest reduction in bleeding at six months, while inj DMPA had the greatest early reduction.
- All treatments improved hemoglobin levels significantly over six months.

## Abstract

Introduction: Heavy menstrual bleeding (HMB) is a prevalent gynecological condition among women in the reproductive and perimenopausal age groups, significantly impairing quality of life. While several medical treatment options are available, their comparative effectiveness and patient adherence vary. This study aimed to evaluate the effectiveness of medical management in HMB.

Methods: This prospective cohort study was carried out at a tertiary care institute in Central India from February 2023 to July 2024. The study included 240 women between 13 and 50 years of age presenting with HMB who opted for medical management. HMB was defined by a Pictorial Blood Loss Assessment Chart (PBAC) score of > 100. Women with HMB secondary to pregnancy complications, women needing surgical management, and women with postmenopausal bleeding were excluded from the study. Medical management was selected based on patient preference and clinical suitability. Outcome parameters like change in PBAC score and hemoglobin level were noted at baseline and reassessed at three and six months.

Results: The mean age of participants was 41.03 ± 7.23 years. Baseline median PBAC scores (IQR) were: levonorgestrel intrauterine system (LNG-IUS) 475 (360-690), tranexamic acid 400 (255-600), norethisterone 645 (350-775), injectable depot medroxyprogesterone acetate (inj DMPA) 690 (355-956), and combined oral contraceptive pills (COCP) 380 (259-580). All five groups showed a significant reduction in PBAC scores at three and six months (p < 0.001). The greatest reduction at three months was seen with inj DMPA (78%), while LNG-IUS showed the highest reduction at six months (93%). A statistically significant improvement in hemoglobin levels was also observed over six months in all groups.

Conclusion: Medical management of HMB was effective in reducing menstrual blood loss and improving hemoglobin levels. LNG-IUS offered the most significant benefit with high compliance, but treatment choice should be individualized based on patient needs and clinical profile.