Overview of treatment options for heavy menstrual bleeding
| . | Hormonal? . | Amenorrhea rate, % . | Contraceptive efficacy, % . | VTE risk? . | Reversible? . |
|---|---|---|---|---|---|
| Levonorgestrel intrauterine system | Yes—progesterone | 50 | >99 | No | Yes |
| Subdermal implant | Yes—progesterone | 20 | >99 | No* | Yes |
| DMPA | Yes—progesterone | 68 | >99 | Yes | Yes |
| Progestin-only pill | Yes—progesterone | 5-10 | 90 (typical use) to 99 (with perfect use)38 | No | Yes |
| Combined hormonal contraceptives | Yes—estrogen and progesterone | Variable | 90 (typical use) to >99 (with perfect use)38 | Yes | Yes |
| Nonhysterectomy procedures | No | Variable39 | Not effective (alternative contraception required) | No | Usually not |
| Hysterectomy | No | 100 | 100 | Temporary around the time of surgery | No |
| Tranexamic acid/antifibrinolytics | No | Not applicable | Not effective (alternative contraception required) | Unclear | Yes |
| . | Hormonal? . | Amenorrhea rate, % . | Contraceptive efficacy, % . | VTE risk? . | Reversible? . |
|---|---|---|---|---|---|
| Levonorgestrel intrauterine system | Yes—progesterone | 50 | >99 | No | Yes |
| Subdermal implant | Yes—progesterone | 20 | >99 | No* | Yes |
| DMPA | Yes—progesterone | 68 | >99 | Yes | Yes |
| Progestin-only pill | Yes—progesterone | 5-10 | 90 (typical use) to 99 (with perfect use)38 | No | Yes |
| Combined hormonal contraceptives | Yes—estrogen and progesterone | Variable | 90 (typical use) to >99 (with perfect use)38 | Yes | Yes |
| Nonhysterectomy procedures | No | Variable39 | Not effective (alternative contraception required) | No | Usually not |
| Hysterectomy | No | 100 | 100 | Temporary around the time of surgery | No |
| Tranexamic acid/antifibrinolytics | No | Not applicable | Not effective (alternative contraception required) | Unclear | Yes |
One study showed a nonsignificant increased risk of VTE among those using the etonogestrel implant, while other studies have shown no increased risk.19–21