What oral progestin (progestogen)-only contraceptive would you suggest to stop abnormal uterine bleeding quickest?

Norethindrone Acetate is the Most Effective Oral Progestin-Only Contraceptive for Stopping Abnormal Uterine Bleeding Quickly

For the quickest resolution of abnormal uterine bleeding, norethindrone acetate at a dose of 5-10 mg daily for 5-10 days is the most effective oral progestin-only contraceptive option. 1

First-Line Treatment Options for Abnormal Uterine Bleeding

• Norethindrone acetate 5-10 mg daily for 5-10 days is FDA-approved specifically for abnormal uterine bleeding due to hormonal imbalance and produces secretory transformation of the endometrium, with bleeding cessation typically occurring within days 1
• For acute bleeding episodes requiring immediate control, high-dose estrogen therapy is traditionally recommended, but when a progestin-only method is required, norethindrone acetate at higher doses (5-10 mg) works most rapidly 2
• Before initiating treatment, rule out underlying gynecological problems such as interactions with medications, STDs, pregnancy, or pathologic uterine conditions (fibroids or polyps) 3

Treatment Algorithm Based on Bleeding Severity

For Heavy or Prolonged Bleeding:

• First-line: Norethindrone acetate 5-10 mg daily for 5-10 days 1
• Alternative options if norethindrone acetate is unavailable or contraindicated:
  • NSAIDs for short-term treatment (5-7 days) 3
  • If medically eligible and progestin-only method not strictly required, low-dose combined oral contraceptives for 10-20 days 3

For Persistent Bleeding Despite Initial Treatment:

• Consider increasing norethindrone acetate dose gradually (can be increased by 2.5 mg every two weeks up to 15 mg daily if needed) 1
• For women using norethindrone progestin-only pills with persistent bleeding, switching to drospirenone progestin-only pills may help reduce bleeding 4
• If bleeding persists and remains unacceptable to the patient, counsel on alternative contraceptive methods 3

Evidence for Rapid Bleeding Control

• Norethindrone acetate at 5-10 mg daily doses acts rapidly to transform the endometrium and stop bleeding, with withdrawal bleeding typically occurring 3-7 days after discontinuing therapy 1
• For comparison, in studies of other progestin-only methods, a combination of depo-medroxyprogesterone acetate 150 mg intramuscular injection plus oral medroxyprogesterone acetate 20 mg every 8 hours for 3 days stopped bleeding in all study participants within 5 days (mean time 2.6 days) 5
• Studies examining treatments for bleeding irregularities with implantable contraceptives found significant cessation of bleeding within 7 days with oral mefenamic acid, but these were not specifically examining oral progestin-only contraceptives 3

Important Considerations and Precautions

• Bleeding patterns with progestin-only contraceptives are often unpredictable, especially during the first 3-6 months of use 3
• Enhanced counseling about expected bleeding patterns and reassurance that bleeding irregularities are generally not harmful has been shown to reduce method discontinuation 3
• For women with recurrent episodes of abnormal uterine bleeding, planned menstrual cycling with norethindrone acetate may be beneficial 1
• If abnormal bleeding persists despite treatment and the woman finds it unacceptable, offer alternative contraceptive methods 3, 6

Long-Term Management

• For women requiring long-term management of abnormal uterine bleeding who prefer progestin-only methods, the levonorgestrel-releasing intrauterine device is the most effective option, reducing menstrual blood loss by 71-95% 6, 7
• For women with persistent bleeding problems who still want an oral progestin-only method, norethindrone acetate can be used cyclically (10 days each month for 6 months) 2
• Patients with a history of recurrent abnormal uterine bleeding may benefit from planned menstrual cycling with norethindrone acetate 1

Remember that while norethindrone acetate is the most effective oral progestin-only option for quickly stopping abnormal uterine bleeding, the levonorgestrel intrauterine device remains the most effective progestin-only contraceptive for long-term management of abnormal uterine bleeding if an oral method is not required 6, 7.