Baseline Heavy Menstrual Bleeding Volume
Heavy menstrual bleeding exceeds normal cycle blood loss thresholds.
- <80 mL: Normal cycle loss (typical reference range)
- >80 mL: HMB threshold (clinical definition cutoff)
- 80–200 mL: Common range simulated (per cycle, this simulator)
- ~30%: Reported prevalence (of menstruating people, lifetime)
Why baseline volume matters for treatment choice
Baseline severity guides which treatment option is prioritized first.
Higher baseline volume often favors the hormonal IUD option.
Tranexamic Acid — Antifibrinolytic Reduction of Menstrual Blood Loss
Taken only during bleeding days, this pill reduces flow non-hormonally.
- ~50%: Typical reduction (vs. untreated cycle)
- Cyclic: Dosing pattern (only during menses)
- 1st cycle: Onset (effect seen immediately)
- None: Hormonal effect (non-hormonal mechanism)
Mechanism of clot-stabilizing action
Blocks plasminogen activation, stabilizing clots and limiting blood loss.
Good option for those avoiding hormonal contraceptives.
Levonorgestrel Hormonal IUD — Local Endometrial Suppression
A local hormone-releasing device thins the lining most effectively.
- ~90%: Typical reduction (largest reduction option)
- 3–8 yrs: Duration (long-acting placement)
- 3–6 months: Onset (full effect delayed)
- Low: Systemic hormone level (localized delivery)
Mechanism of local endometrial thinning
Local levonorgestrel release thins the endometrium, reducing shed volume.
Most effective long-term option among the three compared.
Combined Oral Contraceptives — Cycle Regulation and Flow Reduction
Estrogen-progestin pills regulate cycles and moderately reduce flow.
- ~40%: Typical reduction (moderate reduction option)
- Daily: Dosing pattern (continuous cycle control)
- 1–2 cycles: Onset (gradual improvement)
- Cycle regularity: Added benefit (predictable timing)
Mechanism of combined hormonal regulation
Suppresses ovulation and stabilizes lining growth, lightening flow.
Useful when contraception and cycle control are also desired.
Treatment Comparison Summary — Choosing Between Three Options
Each treatment trades onset speed, reduction size, and convenience.
- IUD ~90%: Best reduction (largest effect size)
- Tranexamic acid: Fastest onset (effective 1st cycle)
- IUD & pill: Added contraception (dual-purpose options)
- Tranexamic acid: Non-hormonal choice (only non-hormonal option)
Selecting the right option for the patient
Choice depends on severity, contraceptive need, and onset preference.
Shared decision-making balances effectiveness against patient preference.