What are the hormonal treatments for uterine bleeding?

From the Guidelines

Hormonal treatments for uterine bleeding should prioritize the use of combined hormonal contraceptives, such as low-dose combined oral contraceptives, as a first-line treatment option, as recommended by the most recent guidelines 1. The treatment of uterine bleeding involves a range of hormonal options, including:

• Combined hormonal contraceptives (CHCs), which can be taken cyclically or continuously to reduce bleeding
• Progestin-only treatments, such as oral medroxyprogesterone acetate or the levonorgestrel intrauterine system
• Hormonal treatments, such as low-dose combined oral contraceptives, which can be used for 10-20 days to treat heavy or prolonged bleeding 1 The choice of treatment depends on the underlying cause of bleeding, the patient's reproductive goals, contraceptive needs, and tolerance of side effects. Key considerations in the management of uterine bleeding include:
• Exploring patient goals and preferences for treatment
• Considering the potential for underlying health conditions, such as interactions with other medications or new pathologic uterine conditions
• Selecting a treatment option that balances efficacy with potential risks and side effects, as outlined in the 2024 guidelines for contraceptive use 1. In cases where medical treatment is not effective or tolerated, surgical options, such as endometrial ablation or hysterectomy, may be considered 1. However, the most recent and highest-quality evidence supports the use of combined hormonal contraceptives as a first-line treatment for uterine bleeding, due to their effectiveness in reducing bleeding and improving quality of life 1.

From the FDA Drug Label

Medroxyprogesterone acetate, administered parenterally in the recommended doses to women with adequate endogenous estrogen, transforms proliferative endometrium into secretory endometrium. In these conditions oral therapy is recommended.

• Hormonal treatments for uterine bleeding include:
  • Medroxyprogesterone acetate (oral therapy)
  • Norethindrone (oral therapy) These treatments can help transform proliferative endometrium into secretory endometrium, which can help reduce uterine bleeding. 2 3

From the Research

Hormonal Treatments for Uterine Bleeding

Hormonal treatments are commonly used to manage uterine bleeding. The following options are available:

• Levonorgestrel-releasing intrauterine system: This treatment is effective in reducing heavy menstrual bleeding 4.
• Combined oral contraceptives: These can be used to treat heavy menstrual bleeding and are often prescribed in a multidose regimen 4, 5.
• Continuous oral progestins: This treatment option is also effective in reducing heavy menstrual bleeding 4.
• Tranexamic acid: This can be used in combination with hormonal methods to decrease menstrual bleeding 4, 5.
• Gonadotropin-releasing hormone agonists: These are indicated in patients with leiomyoma and abnormal uterine bleeding, particularly in preparation for surgical interventions 4.
• Progestin-only methods: These can be used to treat heavy menstrual bleeding, especially in women on anticoagulation therapy 4.
• Parenteral estrogen: This is a viable option for acute abnormal uterine bleeding with a normal uterus 4.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can be used in combination with hormonal methods and tranexamic acid to decrease menstrual bleeding 4, 5.

Progesterone and Progestogens

Progesterone and progestogens play a crucial role in managing abnormal uterine bleeding. They can be used to:

• Regulate intermenstrual bleeding and decrease heavy menstrual bleeding in women of reproductive age or who are perimenopausal 6.
• Prevent endometrial hyperplasia and reduce the development of endometrial cancer in menopausal women 6, 7.
• Act in concert with other hormones to affect breast, cardiovascular system, lipid profile, and bone 6.