Which hormone is used to stop vaginal bleeding?

Progestin Treatment for Vaginal Bleeding

Medroxyprogesterone acetate (MPA) is the most effective progestin for stopping vaginal bleeding, with doses of 5-10 mg daily for 12-14 days being recommended for acute management. 1

Types of Progestins and Their Effectiveness

Progestins work primarily by inducing endometrial secretory changes and stabilizing the endometrium, which helps control abnormal bleeding. The main options include:

1. First choice: Medroxyprogesterone acetate (MPA)

   • Dosage: 5-10 mg daily for 12-14 days 1
   • Most evidence demonstrates full effectiveness in inducing secretory endometrium
   • Widely available with substantial efficacy data

2. Second choice: Natural micronized progesterone (MP)

   • Dosage: 100-200 mg daily for 12-14 days 1
   • Better cardiovascular risk profile than synthetic progestins
   • Minimizes hormonal-related cardiovascular risks
   • Neutral or beneficial effect on blood pressure
   • Better safety profile for thrombotic risk

3. Other options:

   • Dydrogesterone: 10 mg for 12-14 days per month 1
   • Norethisterone acetate: 5 mg daily for 12-14 days 1

Treatment Algorithm for Vaginal Bleeding

For Acute Heavy Bleeding:

1. Rule out pregnancy and structural causes if clinically indicated
2. Start MPA 5-10 mg daily for 12-14 days 1, 2
3. Monitor response - If bleeding persists or is severe, investigate for organic pathology 2

For Recurrent or Chronic Bleeding:

1. Consider administration regimen:

   • Sequential regimen: Progestin for 12-14 days every 28 days (allows for withdrawal bleeding)
   • Continuous regimen: Daily progestin administration (prevents withdrawal bleeding) 1

2. For heavy menstrual bleeding:

   • Consider levonorgestrel-releasing intrauterine system as a highly effective option 1
   • Combined hormonal contraceptives can also be effective 1
   • NSAIDs may be used with hormonal methods to decrease bleeding 1

Special Considerations

For Post-Pubertal Patients with Bleeding:

• First choice: Transdermal 17β-estradiol with progestin 1
• Second choice: Oral 17β-estradiol (1-2 mg daily) with progestin 1

For Unscheduled Bleeding with Hormonal Contraceptives:

• If using extended or continuous combined hormonal contraceptives, unscheduled spotting or bleeding is common during first 3-6 months 1
• If bleeding persists and is unacceptable, consider a hormone-free interval of 3-4 consecutive days 1

Potential Side Effects and Monitoring

• Cardiovascular effects: MPA may negatively impact cardiovascular risk through effects on lipid profiles and carbohydrate metabolism 1
• Bone density: Long-term use of injectable medroxyprogesterone acetate is associated with decreased bone mineral density 2
• Bleeding patterns: Most women using medroxyprogesterone experience disruption of menstrual bleeding patterns initially, but with continued use, irregular bleeding decreases and amenorrhea becomes more common 2

Cautions and Contraindications

• Use with caution in patients with history of:
  • Breast cancer (contraindicated in current breast cancer) 1
  • Thromboembolic events
  • Cardiovascular disease

Remember that if abnormal bleeding persists or is severe despite treatment, further investigation is necessary to rule out underlying pathology such as endometrial hyperplasia, polyps, fibroids, or malignancy 2.