From the Guidelines
For adolescents with dysfunctional uterine bleeding (DUB), combined oral contraceptive pills (COCs) containing 30-35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate are the recommended first-line treatment. When selecting a COC, it is essential to consider the patient's medical history and potential contraindications, such as severe and uncontrolled hypertension, ongoing hepatic dysfunction, or complicated valvular heart disease 1. The benefits of COCs in adolescents with DUB include regulation of menstrual bleeding, reduction of dysmenorrhea, and improvement of acne, as well as protection against endometrial and ovarian cancers 1. Key considerations for COC use in adolescents include:
- Starting with a low-dose pill (containing ethinyl estradiol 35 μg or less) and a progestin such as levonorgestrel or norgestimate
- Counseling patients on the importance of daily adherence and providing strategies to promote adherence, such as cell phone alarms and support from a family member or partner 1
- Informing patients about potential adverse effects, including irregular bleeding, headache, and nausea, and providing guidance on managing these effects 1
- Recommending a follow-up visit 1 to 3 months after initiating COCs to address any adverse effects or adherence issues 1. In terms of specific treatment regimens, a monophasic pill containing 30-35 mcg of ethinyl estradiol with a progestin such as norgestimate or levonorgestrel can be used, and extended or continuous cycles may be useful for treating medical conditions such as anemia, acne, or severe dysmenorrhea 1.
From the Research
Oral Contraceptives for Dysfunctional Uterine Bleeding (DUB) in Adolescents
- The use of oral contraceptives in adolescents with DUB can help regulate menstrual cycles and reduce bleeding symptoms 2.
- Combined oral contraceptive pills (COCs) are commonly used for this purpose, but the choice of pill should be individualized based on the patient's needs and medical history 2.
- Progestin-only pills (POPs) are also an option, but may not be as effective in regulating menstrual cycles as COCs 2.
Types of Oral Contraceptives
- Low-dose COCs (containing 20 microg of ethinyl estradiol) may be a good option for adolescents with DUB, as they can help reduce bleeding symptoms while minimizing the risk of thromboembolic complications 3, 4.
- However, the use of low-dose COCs in adolescents has been shown to affect bone mineral density (BMD), with some studies suggesting that it may lead to a decrease in BMD 3, 5.
- Ultra-low-dose COCs (containing 15 microg of ethinyl estradiol) may also be an option, but their effect on BMD is not well established 6.
Considerations for Adolescent Patients
- When prescribing oral contraceptives to adolescents with DUB, it is essential to consider the patient's age, medical history, and lifestyle 2.
- The patient's bone health should also be taken into account, as the use of hormonal contraceptives during adolescence may affect peak bone mass acquisition 3, 5.
- Regular follow-up appointments should be scheduled to monitor the patient's response to treatment and adjust the contraceptive regimen as needed 2.