From the Guidelines
Treatment for Abnormal Uterine Bleeding (AUB) should prioritize medical management with hormonal medications, such as combined oral contraceptives or progestin-only options, to regulate bleeding patterns and address hormonal imbalances, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1, 2, 3.
Treatment Options
- Medical treatments: + Combined oral contraceptives (e.g., ethinyl estradiol 30-35 mcg with progestin) taken cyclically for 3-6 months to regulate bleeding patterns + Progestin-only options like medroxyprogesterone acetate 10 mg daily for 10-14 days per month or levonorgestrel-releasing intrauterine devices (Mirena) for effective management with the added benefit of contraception
- Non-hormonal options: + Nonsteroidal anti-inflammatory drugs like ibuprofen 600-800 mg three times daily during menses to reduce blood loss by 20-40% by decreasing prostaglandin production + Tranexamic acid 1000-1300 mg three times daily during menstruation for acute heavy bleeding
- Surgical options: + Endometrial ablation or hysterectomy for women who have completed childbearing and do not respond to medical therapy
Considerations
- Underlying gynecological problems, such as interactions with other medications, STDs, pregnancy, or new pathologic uterine conditions, should be considered and treated or referred for care 4, 5, 6
- Patient age and desire for fertility should be taken into account when selecting a treatment option
- The PALM-COEIN classification system can help identify the underlying cause of AUB and guide treatment decisions 1
Recommendations
- First-line treatment should include hormonal medications to regulate bleeding patterns and address hormonal imbalances 1, 2, 3
- Non-hormonal options and surgical options should be considered for women who do not respond to medical therapy or have contraindications to hormonal treatments
- Patient education and counseling on treatment options and potential risks and benefits are essential for informed decision-making 2, 4, 5, 6
From the Research
Treatment Options for Abnormal Uterine Bleeding (AUB)
The treatment options for AUB can be categorized into medical and surgical therapies.
- Medical therapies include: + Hormonal therapies such as combined oral contraceptives, progestin-only preparations, and intrauterine release of levonorgestrel through the levonorgestrel-releasing intrauterine system 7, 8, 9, 10 + Non-hormonal therapies such as non-steroidal anti-inflammatory drugs and antifibrinolytic drugs 8, 9 + Other medical therapies such as danazol, gonadotrophin-releasing hormone analogues, and hormone replacement therapy 7, 9
- Surgical therapies include: + Endometrial ablation 8 + Hysterectomy 7, 8
Medical Management
The choice of medical therapy depends on the underlying cause of AUB, the patient's symptoms, and her need for fertility or contraception 9.
- For patients with anovulatory dysfunctional uterine bleeding, medical management options include oral contraceptives, progestin-only preparations, and clomiphene citrate 7
- For patients with ovulatory dysfunctional uterine bleeding, medical management options include prolonged progestin use, oral contraceptives, non-steroidal anti-inflammatory drugs, antifibrinolytic agents, danazol, and gonadotropin-releasing hormone agonists 7
Surgical Management
Surgical therapy may be considered for patients who no longer desire future fertility, have associated pelvic pathologic disorders, or have failed all medical regimens 7.