Managing Heavy Menstrual Bleeding in Women at Risk of Thrombosis

Clin Obstet Gynecol. 2018 Jun;61(2):250-259. doi: 10.1097/GRF.0000000000000372.


Management of heavy menstrual bleeding (HMB) in a woman with a history of thrombosis, or who is otherwise at high risk of thrombosis, or who takes medications for anticoagulation can present a challenge to health care providers. The goal of treating HMB is to reduce menstrual blood loss. First-line therapy is typically hormonal, and hormonal therapy can be contraindicated in women with a history of thrombosis unless they are on anticoagulation. As 70% of women on anticoagulation experience HMB, successful management of HMB may involve a modification in the anticoagulation or antiplatelet regimen, hormonal therapy tailored to the patient's situation, and/or surgical therapy.

Publication types

  • Review

MeSH terms

  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects*
  • Antifibrinolytic Agents / therapeutic use
  • Balloon Occlusion
  • Blood Coagulation Tests
  • Contraceptives, Oral, Hormonal / administration & dosage
  • Contraceptives, Oral, Hormonal / adverse effects
  • Contraindications, Drug
  • Endometrial Ablation Techniques
  • Female
  • Humans
  • Hysterectomy
  • Medical History Taking
  • Menorrhagia / complications
  • Menorrhagia / therapy*
  • Physical Examination
  • Risk
  • Shock / etiology
  • Shock / prevention & control
  • Thrombosis / drug therapy
  • Thrombosis / prevention & control*


  • Anticoagulants
  • Antifibrinolytic Agents
  • Contraceptives, Oral, Hormonal