How can Estarylla (norgestimate and ethinyl estradiol) be used to regulate abnormal uterine bleeding?

Using Estarylla to Regulate Abnormal Uterine Bleeding

Estarylla (norgestimate and ethinyl estradiol) is an effective first-line treatment for abnormal uterine bleeding associated with ovulatory dysfunction and can significantly reduce bleeding irregularities when taken daily as directed. 1, 2

Mechanism and Effectiveness

Estarylla works to regulate abnormal uterine bleeding through several mechanisms:

• Provides consistent hormonal levels that stabilize the endometrium
• Prevents ovulation, reducing hormonal fluctuations that can cause irregular bleeding
• Creates a thin, atrophic endometrium that reduces overall menstrual flow

Administration Guidelines

• Take one active tablet daily for 21 days, followed by one inactive tablet daily for 7 days 2
• For maximum effectiveness, take at the same time each day and at intervals not exceeding 24 hours 2
• Can be started using either:
  • Sunday Start: Begin first tablet on the first Sunday after menstruation begins
  • Day 1 Start: Begin first tablet on the first day of menstrual flow

Managing Missed Pills

If you miss pills, follow these specific instructions to maintain effectiveness:

• One missed active pill: Take as soon as remembered, then continue regular schedule
• Two missed active pills (Week 1 or 2): Take two pills immediately, two pills the next day, then resume normal schedule
• Two missed pills in Week 3 or three or more missed pills: Discard pack and start a new pack that same day
• Always use backup contraception for 7 days after missing pills 2

Expected Results and Timeline

• Improvement in bleeding patterns typically begins within 1-3 months
• Full stabilization of bleeding patterns may take up to 3 months of consistent use
• Some patients may experience spotting or breakthrough bleeding during the first 3 months of use

Potential Side Effects

• Breakthrough bleeding or spotting, especially during the first few months
• Nausea, breast tenderness, headaches
• Mood changes
• Fluid retention

Contraindications

Estarylla should not be used in patients with:

• Blood pressure: systolic >160 mm Hg, diastolic >100 mm Hg
• History of deep vein thrombosis or thromboembolic disorders
• Diabetes with vascular involvement
• Headaches with focal neurologic symptoms
• Hepatic adenomas or carcinomas 1

Alternative Options for Abnormal Bleeding

If Estarylla is contraindicated or not tolerated:

1. Progestin-only methods:

   • Progestin-only pills
   • Levonorgestrel intrauterine device (reduces menstrual blood loss by 40-50%) 3

2. Non-hormonal options:

   • NSAIDs for short-term treatment (5-7 days) during days of bleeding 1
   • Tranexamic acid 4

Follow-up Recommendations

• Schedule follow-up at 3 months to assess effectiveness and side effects 5
• If bleeding irregularities persist beyond 3 months and are unacceptable:
  • Consider increasing estrogen content from 20 mcg to 35 mcg per day
  • Consider decreasing the hormone-free interval from seven to four or five days 5

Important Considerations

• Counsel patients about potential changes in bleeding patterns before starting treatment
• Abnormal bleeding should improve within 3 months; if it persists, reevaluation may be necessary
• For acute heavy bleeding episodes, higher-dose estrogen therapy may be required initially 6
• If medical treatment fails or is not tolerated, surgical options including endometrial ablation may be considered for women who have completed childbearing 1

Remember that while regulating abnormal bleeding, Estarylla also provides effective contraception with a typical failure rate of 5-9% 3.