From the Guidelines
Irregular menstruation caused by estrogen and progesterone imbalances can be effectively managed with hormonal treatments, such as combined oral contraceptives or estrogen therapy, as well as non-hormonal options like nonsteroidal anti-inflammatory drugs (NSAIDs) or antifibrinolytic agents, as recommended by the most recent guidelines 1.
Treatment Options
The treatment options for irregular menstruation caused by hormonal imbalances include:
- Hormonal treatments, such as combined oral contraceptives (e.g., 20–30 μg ethinylestradiol) or estrogen therapy, which can help regulate the menstrual cycle and improve bleeding irregularities 1
- Non-hormonal options, such as NSAIDs (e.g., celecoxib, ibuprofen, or mefenamic acid) or antifibrinolytic agents (e.g., tranexamic acid), which can help reduce bleeding and improve symptoms 1
- Selective estrogen receptor modulators (SERMs) (e.g., tamoxifen), which may also be effective in improving bleeding irregularities 1
Approach to Management
When managing irregular menstruation caused by hormonal imbalances, it is essential to:
- Explore patient goals and preferences, including continued use of contraceptive methods or treatment for bleeding irregularities 1
- Consider underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, and treat or refer for care as needed 1
- Provide reassurance and advise patients to contact their provider if they experience bleeding irregularities or other side effects 1
Key Considerations
When selecting a treatment option, consider the patient's preferences, treatment goals, and medical history, as well as the potential benefits and risks of each treatment, as outlined in the most recent guidelines 1.
From the FDA Drug Label
Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral contraceptives. In breakthrough bleeding, as in all cases of irregular bleeding from the vagina, non-functional causes should be borne in mind In undiagnosed persistent or recurrent abnormal bleeding from the vagina, adequate diagnostic measures are indicated to rule out pregnancy or malignancy. If both pregnancy and pathology have been excluded, time or a change to another preparation may solve the problem Changing to an oral contraceptive with a higher estrogen content, while potentially useful in minimizing menstrual irregularity, should be done only if necessary since this may increase the risk of thromboembolic disease
The treatment options for irregular menstruation caused by estrogen and progesterone imbalances include:
- Time: Allowing time to pass may solve the problem.
- Change to another preparation: Switching to a different oral contraceptive may help.
- Changing to an oral contraceptive with a higher estrogen content: This may be useful in minimizing menstrual irregularity, but it should be done only if necessary due to the increased risk of thromboembolic disease. It is essential to rule out pregnancy or malignancy through adequate diagnostic measures before considering these options 2.
From the Research
Treatment Options for Irregular Menstruation
The treatment options for irregular menstruation caused by estrogen and progesterone imbalances include:
- Hormonal therapies, such as oral contraceptives, to regulate menstrual cycles and reduce symptoms 3, 4
- Continuous-use combination oral contraceptives, such as ethinylestradiol/levonorgestrel, to suppress gonadotropins and ovulation, and reduce breakthrough bleeding 3
- Hormone replacement therapy (HRT) to alleviate symptoms of menopause and regulate menstrual cycles, although this may be associated with breakthrough bleeding 5
Mechanisms of Treatment
The mechanisms of treatment for irregular menstruation involve:
- Suppressing gonadotropins and ovulation to regulate menstrual cycles 3
- Regulating estrogen and progesterone levels to reduce symptoms of irregular menstruation 6
- Using progestin and estrogen potency and dose to reduce bleeding days 4
Importance of Evaluating Menstrual Irregularities
Evaluating the factors associated with irregular menstruation is necessary to determine appropriate preventive and treatment strategies and to decrease associated health problems, such as metabolic syndrome, coronary heart disease, and infertility 7
Approaches to Evaluation and Treatment
Approaches to the evaluation and treatment of intermenstrual bleeding with contraceptive methods are reviewed, and patient education on expected bleeding patterns is essential to compliance and continuation 4