From the Guidelines
Hormonal treatment options for uterine bleeding include combined hormonal contraceptives and progestin-only contraception, as recommended by the American College of Obstetricians and Gynecologists 1. These options are often considered first-line therapy for managing abnormal uterine bleeding associated with ovulatory dysfunction.
- Combined hormonal contraceptives, such as combined oral contraceptives, can help regulate bleeding and are commonly used for this purpose.
- Progestin-only options, including oral progestin and the levonorgestrel intrauterine system, can also be effective in managing uterine bleeding. The choice of hormonal treatment depends on various factors, including the severity of bleeding, underlying cause, contraceptive needs, and future fertility desires. According to a more recent study 1, GnRH agonists can also be used to manage bleeding symptoms, especially in women with uterine leiomyomas, but their use is typically limited to temporary situations due to potential drawbacks such as bone density loss. It is essential to consider the potential benefits and risks of each hormonal option and to individualize treatment based on the specific needs and circumstances of each patient.
From the FDA Drug Label
In cases of undiagnosed, persistent or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy The addition of a progestin product to an estrogen replacement regimen for seven or more days of a cycle of estrogen administration have reported a lowered incidence of endometrial hyperplasia Medroxyprogesterone acetate, administered parenterally in the recommended doses to women with adequate endogenous estrogen, transforms proliferative endometrium into secretory endometrium.
The hormonal treatment options for patients with uterine bleeding include:
- Progestin therapy, such as medroxyprogesterone acetate, which can transform proliferative endometrium into secretory endometrium and reduce the incidence of endometrial hyperplasia when added to an estrogen replacement regimen 2 2.
- Estrogen replacement regimen with the addition of a progestin product for seven or more days of a cycle of estrogen administration to lower the incidence of endometrial hyperplasia 2.
From the Research
Hormonal Treatment Options
The following hormonal treatment options are available for patients with uterine bleeding:
- Combined oral contraceptives (COC) 3, 4, 5, 6
- Progestin-only pills (POP) 3, 4, 5
- Levonorgestrel-releasing intrauterine system (LNG-IUS) 3, 4, 5, 6
- Depo-medroxyprogesterone acetate (DMPA) 3
- Progestin implant 3
- Gonadotropin-releasing hormone (GnRH) agonists 4
- Estradiol 3
- Tranexamic acid 4
Specific Treatment Options
For patients with specific types of uterine bleeding, the following treatment options are available:
- For heavy menstrual bleeding: LNG-IUS, COC, continuous oral progestins, and tranexamic acid 4, 6
- For abnormal uterine bleeding associated with hormonal contraception: nonsteroidal anti-inflammatory drugs, estradiol, and changing to a different hormonal contraceptive method 3
- For patients with leiomyoma and abnormal uterine bleeding: GnRH agonists 4
- For women with inherited bleeding disorders: hormonal methods and tranexamic acid 4
- For women on anticoagulation therapy: progestin-only methods and GnRH agonists 4
Comparison of Treatment Options
Studies have compared the effectiveness of different hormonal treatment options for uterine bleeding, including:
- A randomized trial comparing the 52-mg levonorgestrel system with combination oral contraceptives for treatment of heavy menstrual bleeding found no differences in bleeding-related quality of life between the two groups 6
- A review of the literature on extended-cycle combined oral contraceptives found that they are effective in reducing menstrual bleeding and improving quality of life 7