title: Medical treatment of idiopathic heavy menstrual bleeding. What is new? An evidence based approach.
abstract: BACKGROUND
  Heavy menstrual bleeding (HMB) is an important health problem affecting up to 30 % of reproductive age women, interfering with their quality of life. Medical therapy, with the avoidance of unnecessary surgery, is an attractive option.
  
  
  OBJECTIVE
  To provide a comprehensive review of the current medical treatments available for idiopathic HMB and to focus on the newly introduced modalities. Furthermore, to provide a practical algorithm based on the best available evidence.
  
  
  METHODS
  A PubMed search was conducted looking for the different trials, reviews and various guidelines relating to medical treatment of idiopathic HMB.
  
  
  RESULTS
  The most effective medical treatment for idiopathic HMB is the levonorgestrel-releasing intrauterine system. It provides a reliable long-term effect. Importantly, there is a growing scientific evidence for new modalities entailing; modified-release formulation of tranexamic acid, the new four-phasic estradiol valerate/dienogest contraceptive pills and combined contraceptive vaginal ring. Also, vaginal danazol has been tried.
  
  
  CONCLUSIONS
  Maintenance of status quo, i.e., keeping first-line treatment of idiopathic HMB as medical treatment is an essential issue. Modified-release formulation of tranexamic acid, the new four-phasic contraceptive pills and contraceptive vaginal ring are recently added to the medical armamentarium for treatment of idiopathic HMB increasing its efficacy.
authors.affiliation: Department of Obstetrics and Gynecology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. hatem_ah@hotmail.com
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
mesh_terms: D000282:Administration, Intravaginal; D000465:Algorithms; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003274:Contraceptive Devices, Female; D003613:Danazol / Q000627:therapeutic use*; D003661:Decision Support Techniques; D003692:Delayed-Action Preparations; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D008595:Menorrhagia / Q000188:drug therapy*; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004965:Estrogen Antagonists; D014148:Tranexamic Acid; D003613:Danazol