What's a progesterone medication that helps stop vaginal bleeding?

Norethindrone Acetate for Vaginal Bleeding

Norethindrone acetate is the most effective progesterone medication for stopping vaginal bleeding, with a recommended dosage of 5-10 mg daily for 5-10 days to treat abnormal uterine bleeding due to hormonal imbalance. 1

Mechanism and Efficacy

Norethindrone acetate works by transforming the endometrium that has been primed with estrogen, leading to withdrawal bleeding within 3-7 days after discontinuing therapy. This medication is particularly effective for:

• Abnormal uterine bleeding due to hormonal imbalance
• Secondary amenorrhea
• Endometriosis-related bleeding
• Bleeding associated with progesterone-only contraceptive pills 1, 2

Research demonstrates that adding 5 mg norethindrone acetate to progesterone-only pills significantly reduces bleeding frequency and overall bleeding quantity, with improvements observed as early as 2 weeks after starting treatment 2.

Dosing Recommendations

For abnormal uterine bleeding:

• Initial dose: 5-10 mg daily for 5-10 days 1
• For recurrent episodes: Consider planned menstrual cycling with norethindrone acetate 1

For endometriosis:

• Start with 5 mg daily for two weeks
• Increase by 2.5 mg every two weeks until reaching 15 mg daily
• Continue for 6-9 months or until breakthrough bleeding requires temporary cessation 1

Alternative Progesterone Options

1. Levonorgestrel-releasing intrauterine device (LNG-IUD):

   • Significantly reduces menstrual bleeding 3
   • More effective than oral medications for heavy menstrual bleeding 3
   • Associated with improved quality of life 3
   • Particularly beneficial for women with bleeding disorders 4

2. Depot medroxyprogesterone acetate (DMPA):

   • Efficacy of 94-97% (typical failure rate 0.3-6%) 4
   • May reduce vasomotor symptoms 4
   • Potential risk of decreased bone mineral density 4

Clinical Considerations

When to Use Norethindrone Acetate

• For acute management of abnormal uterine bleeding
• When rapid control of bleeding is needed
• For patients who cannot or prefer not to use intrauterine devices
• As adjunctive therapy for breakthrough bleeding with hormonal contraceptives 2, 5

Potential Side Effects

• Minor adverse effects may include pelvic pain and breast tenderness 3
• Monitor for hypoestrogenic side effects with prolonged use
• Generally well-tolerated compared to other hormonal treatments 2

Important Caveats

• Rule out organic pathology before initiating therapy 1
• Patients with history of thromboembolic events may require alternative treatments 4
• Breakthrough bleeding may occur, especially in the first few months of treatment
• Regular follow-up is recommended to assess response to treatment 4

Treatment Algorithm for Vaginal Bleeding

1. First-line for acute bleeding: Norethindrone acetate 5-10 mg daily for 5-10 days 1
2. For recurrent bleeding: Consider LNG-IUD for long-term management 3
3. For contraceptive users with bleeding:
   • For progesterone-only pill users: Add 5 mg norethindrone acetate 2
   • For LNG-IUD users: Consider NSAIDs first, then add estradiol if ineffective 5
   • For implant or DMPA users: Consider combined oral contraceptives or NSAIDs 5

By following this approach, most cases of abnormal vaginal bleeding can be effectively managed, with norethindrone acetate serving as a reliable first-line treatment option for acute episodes.