Treatment

This is dependent on cause e.g. -

• polyps or small fibroids – can be removed hysteroscopically
• larger fibroids – drugs, vascular embolisation, surgery, or a combination of these methods

Iron supplements may be prescribed if there is anaemia secondary to bleeding (1).

If a patient is suffering from intermenstrual bleeding whilst on the oral contraceptive pill and other causes have been excluded:

• it is not generally recommended that a combined oral contraceptive pill is changed within the first 3 months of use as bleeding disturbances often settle in this time
• for women using a combined oral contraceptive pill the lowest dose of ethinylestradiol (EE) to provide good cycle control should be used. However, the dose of EE can be increased to a maximum of 35 µg to provide good cycle control.

Reference:

• (1) Lumsden MA, Gebbie A, Holland C. Managing unscheduled bleeding in non-pregnant premenopausal women. BMJ. 2013;346:f3251.
• (2) FSRH (2015). Problematic bleeding with hormonal contraception.