What is the initial treatment for abnormal uterine bleeding?

From the Guidelines

The initial treatment for abnormal uterine bleeding should be hormonal therapy, specifically combined oral contraceptives or progestin-only options, as they are effective in reducing bleeding and are recommended by recent guidelines 1. The choice of treatment depends on the underlying cause of the bleeding, as well as the patient's medical history and preferences.

• Combined oral contraceptives, such as ethinyl estradiol 35 mcg/norethindrone 1 mg daily, can be used for 21 days followed by 7 days off, or continuous use if needed.
• Progestin-only options, like medroxyprogesterone acetate 10 mg daily for 10-14 days per month or levonorgestrel-releasing intrauterine devices, can also effectively reduce bleeding.
• Non-hormonal options, such as tranexamic acid (1000-1300 mg three times daily during bleeding) or NSAIDs like ibuprofen (600-800 mg three times daily during bleeding), can be used for acute heavy bleeding episodes. It is essential to assess the patient for underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, before initiating treatment 1. Before starting treatment, a pregnancy test should be performed, and patients should be assessed for anemia, with iron supplementation provided if hemoglobin levels are low. If bleeding is extremely heavy or the patient is hemodynamically unstable, immediate medical attention is necessary. The most recent guidelines from 2024 recommend considering the patient's goals and preferences when selecting a treatment option, and providing counseling on alternative contraceptive methods if needed 1.

From the Research

Initial Treatment for Abnormal Uterine Bleeding

The initial treatment for abnormal uterine bleeding typically involves medical management, with the goal of controlling bleeding, regulating menstrual cycles, and improving quality of life 2, 3, 4, 5.

• Medical Management: Medical management is the first-line approach for treating abnormal uterine bleeding, and it involves the use of various medications to control bleeding and regulate menstrual cycles 2, 3, 4, 5.
• Treatment Options: Treatment options for abnormal uterine bleeding include:
  • Levonorgestrel-releasing intrauterine system (LNG-IUS) 2, 3, 4
  • Combined oral contraceptives (COCs) 2, 3, 4
  • Progestin-only pills (POPs) 2, 3, 4
  • Tranexamic acid 2, 3, 4
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4
  • Gonadotropin-releasing hormone (GnRH) agonists 2, 3
• Acute Abnormal Uterine Bleeding: In cases of acute abnormal uterine bleeding, parenteral estrogen, multidose combined oral contraceptive regimen, multidose progestin-only regimen, and tranexamic acid are viable options 2.
• Chronic Abnormal Uterine Bleeding: For chronic abnormal uterine bleeding, medical management options include LNG-IUS, COCs, POPs, tranexamic acid, and NSAIDs 3, 4.
• Hormonal Contraception: Abnormal uterine bleeding associated with hormonal contraception can be treated with specific algorithms, including the use of nonsteroidal anti-inflammatory drugs, estradiol, and changes to the contraceptive method 6.

Considerations for Treatment

When selecting a treatment option, it is essential to consider the individual patient's medical history, risk factors, and diagnosis to determine the most appropriate medical regimen 2, 3, 4, 5.