A 28-year-old woman with heavy menstrual bleeding and iron-deficiency anemia. What is a long-term management option to reduce menses-related blood loss?

• A. Hormonal therapy such as combined oral contraceptives or LNG-IUD; treat iron deficiency with supplementation
• B. Iron supplementation only
• C. Hysterectomy
• D. NSAIDs only

Answer: (A)

The main idea is controlling heavy menstrual bleeding with a long-term approach that reduces cycle blood loss. Hormonal therapy does this by suppressing ovulation and thinning the endometrium, which greatly decreases how much bleeding occurs each month. Options like combined oral contraceptives or a levonorgestrel-releasing intrauterine device are effective for reducing menses, and they also help with iron-deficiency anemia by limiting ongoing blood loss. Iron supplementation is important to treat the existing anemia, but it doesn’t address the underlying heavy bleeding over time. NSAIDs can help modestly but aren’t as durable or impactful as hormonal options. Hysterectomy is a drastic step not appropriate for a young patient when less invasive, effective long-term therapies exist.