What is the initial treatment for dysfunctional uterine bleeding?

From the Guidelines

The initial treatment for dysfunctional uterine bleeding typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, 5-7 days, as the first-line option. This approach is based on the most recent guidelines from the US Department of Health and Human Services, Centers for Disease Control and Prevention, MMWR Recommendations and Reports, 2024 1. The treatment options may vary depending on the patient's preferences, treatment goals, and medical history.

Treatment Options

• NSAIDs, 5-7 days, are recommended for spotting or light bleeding, or for heavy or prolonged bleeding in Cu-IUD, LNG-IUD, implant, and injectable users 1.
• Hormonal treatment, such as low-dose combined oral contraceptives (COCs) or estrogen, 10-20 days, may be considered for heavy or prolonged bleeding in implant users 1.
• Antifibrinolytic agents, such as tranexamic acid, 5 days, may be used for heavy or prolonged bleeding in implant users 1.
• It is essential to explore patient goals, including continued method use or method discontinuation, and to consider underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions 1.

Important Considerations

• Before initiating treatment, it is crucial to rule out pregnancy and other causes of abnormal uterine bleeding through history, physical examination, and appropriate laboratory tests.
• Iron supplementation should be considered for patients with anemia resulting from chronic bleeding.
• The PALM-COEIN classification system can be used to describe uterine bleeding abnormalities in women of reproductive age, including structural and nonstructural causes 1.

Key Takeaways

• NSAIDs are the first-line treatment for dysfunctional uterine bleeding, with hormonal and antifibrinolytic agents being alternative options.
• Treatment should be individualized based on patient preferences, treatment goals, and medical history.
• Underlying health conditions should be considered and ruled out before initiating treatment.

From the FDA Drug Label

For treatment of abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology: One 25 mg injection, intravenously or intramuscularly. The initial treatment for dysfunctional uterine bleeding is 25 mg of conjugated estrogens administered intravenously or intramuscularly. Key points to consider include:

• The dose can be repeated in 6 to 12 hours if necessary.
• Intravenous use is preferred for a more rapid response.
• It is essential to inject slowly to avoid flushes. 2

From the Research

Initial Treatment for Dysfunctional Uterine Bleeding

The initial treatment for dysfunctional uterine bleeding can vary depending on the patient's specific needs and circumstances. Some common treatment options include:

• Medical therapy, such as anti-fibrinolytic tranexamic acid, non-steroidal anti-inflammatory drugs, the combined contraception pill, progestogen, danazol, or analogues of gonadotrophin releasing hormone 3
• The levonorgestrel releasing intra uterine device, which is effective in treating dysfunctional uterine bleeding and can be used for contraception as well 3, 4
• Surgical treatment, such as endometrial ablation or hysterectomy, which may be considered for patients who do not respond to medical therapy or who have associated pelvic pathologic disorders 3, 5

Treatment Options for Specific Patient Groups

Different patient groups may require different treatment approaches. For example:

• Adolescents with anovulatory dysfunctional uterine bleeding may be treated with medroxyprogesterone acetate or oral contraceptives 5, 4
• Women of reproductive age with anovulatory bleeding episodes who also require contraception may be treated with oral contraceptives 5
• Perimenopausal patients with dysfunctional uterine bleeding may be treated with cyclic progestin or cyclic conjugated equine estrogens, or with low-dose combination oral contraceptives if they are nonsmokers and do not have evidence of vascular disease 5
• Patients with ovulatory dysfunctional uterine bleeding may require long-term therapy directed at reducing menstrual blood loss, such as prolonged progestin use, oral contraceptives, nonsteroidal antiinflammatory drugs, antifibrinolytic agents, danazol, or gonadotropin-releasing hormone agonists 5

Considerations for Treatment Choice

The choice of treatment for dysfunctional uterine bleeding should be based on factors such as the mechanism behind the bleeding, the patient's symptoms, and their need for fertility or contraception 6. Additionally, the patient's overall health and medical history should be taken into account when selecting a treatment option.