Treatment of Uterine Fibroids with Abnormal Uterine Bleeding

Uterine fibroids presenting alongside abnormal uterine bleeding require targeted medical management. Patients in this scenario may experience heavy menstrual bleeding and associated anemia, and should also be evaluated for other concurrent causes of abnormal uterine bleeding.

Clinical Scenario

This protocol addresses patients with uterine fibroids who present with abnormal uterine bleeding. Fibroid patients with this combination may be offered a range of medical interventions targeting menstrual blood loss and its hematologic consequences. Evaluation should account for the possibility of other concurrent causes of abnormal uterine bleeding in this population.

Treatment Approach (Partial Overview)

Medical management centres on reducing heavy menstrual bleeding and correcting associated anemia. The approach involves hematologic support alongside several distinct classes of menstrual suppression therapy — the complete structured regimen, including agent selection, sequencing, and clinical decision criteria, is available in the full protocol.

Clinical goals include a meaningful reduction in menstrual blood loss, improvement in hemoglobin levels, and reduction in uterine volume. Full regimen details remain in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jogc.2025.102970

Fibroid patients with abnormal uterine bleeding may be offered menstrual suppression with oral contraceptives, progestins (including the levonorgestrel intrauterine system), gonadotropin-releasing hormone agonists, gonadotropin-releasing hormone antagonists, and danazol.
Patients presenting with fibroids and abnormal uterine bleeding (AUB) remain at risk of other causes of AUB.
Tranexamic acid may be offered to patients with fibroids to specifically reduce heavy menstrual bleeding.
Anemia should be corrected with iron supplementation and consideration of menstrual suppression prior to elective surgery.

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