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Hormonal options

Hormonal treatments thin or stabilize the uterine lining. They are the most widely used treatments for heavy and irregular bleeding, and many also provide contraception.

By the AUB editorial teamUpdated September 2026

Levonorgestrel IUD

A small device placed in the uterus that releases a progestin locally. The 52 mg levonorgestrel IUD is FDA-approved to treat heavy menstrual bleeding in people who also want contraception. It reduces bleeding substantially, and many users have very light periods or none. Irregular spotting is common in the first months. Placement happens in the office.

Combined hormonal birth control

The pill, patch, or ring contain estrogen and a progestin. They make bleeding lighter and predictable and can be taken continuously to skip periods. They are not safe for everyone. Estrogen is generally avoided in people who smoke and are over 35, and in people with migraine with aura, a history of blood clots, certain heart or liver conditions, or breast cancer.

Progestin-only options

Oral progestins, such as norethindrone acetate or medroxyprogesterone, can be taken for part of each month or continuously. They are useful when estrogen is not an option. The injection and implant also reduce bleeding for some people but can cause unpredictable spotting.

What to weigh

  • Whether you want contraception, or a pregnancy soon
  • Your risk factors for blood clots
  • Side effects you would rather avoid
  • Whether the cause, such as a large fibroid inside the cavity, makes an IUD less likely to work

Sources

  1. American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206 (reaffirmed).
  2. American College of Obstetricians and Gynecologists. Practice Bulletin No. 136: Management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstet Gynecol. 2013;122(1):176–185 (reaffirmed).
  3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 228: Management of symptomatic uterine leiomyomas. Obstet Gynecol. 2021;137(6):e100–e115.

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