What are the treatment options for Abnormal Uterine Bleeding (AUB)?

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.

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 1
• 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
• 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 1

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 2, 3, 4, 5
  • Non-hormonal therapies such as non-steroidal anti-inflammatory drugs and antifibrinolytic drugs 3, 4
  • Other medical therapies such as danazol, gonadotrophin-releasing hormone analogues, and hormone replacement therapy 2, 4
• Surgical therapies include:
  • Endometrial ablation 3
  • Hysterectomy 2, 3

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 4.

• For patients with anovulatory dysfunctional uterine bleeding, medical management options include oral contraceptives, progestin-only preparations, and clomiphene citrate 2
• 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 2

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 2.

• Hysterectomy is a traditional standard of care for AUB, but it has a relatively high complication rate 3
• Endometrial ablation is a less invasive surgical option that can be effective in reducing menstrual blood loss, but it may have a learning curve and long-term follow-up data are limited 3