From the Guidelines
Treatment for perimenopausal irregular uterine bleeding should prioritize hormonal therapy, with options including combined hormonal contraceptives, cyclic progestins, and the levonorgestrel intrauterine system, as these have been shown to effectively regulate cycles and reduce bleeding 1. When considering treatment options, it's essential to explore patient goals and preferences, including continued method use or method discontinuation, and to advise patients that they may contact their provider at any time to discuss bleeding irregularities or other side effects 1. For women using different contraceptive methods, various treatment options may be considered:
- For Cu-IUD users, treatment options include NSAIDs for 5-7 days for spotting or light bleeding, or for heavy or prolonged bleeding 1.
- For implant users, treatment options include NSAIDs for 5-7 days for spotting or light bleeding, or for heavy or prolonged bleeding, as well as hormonal treatment, such as low-dose COCs or estrogen, for 10-20 days, or antifibrinolytic agents, such as tranexamic acid, for 5 days 1.
- For CHC users, a hormone-free interval for 3-4 consecutive days may be considered, but this is not recommended during the first 21 days of extended or continuous CHC use, and not more than once per month, as it may reduce contraceptive effectiveness 1. Non-hormonal options, such as tranexamic acid or nonsteroidal anti-inflammatory drugs, may also be considered for women who cannot take estrogen or prefer not to use hormonal therapy 1. It's crucial to rule out underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, and to treat or refer for care if an underlying condition is found 1. Key considerations in treatment selection include patient preferences, treatment goals, and medical history, as well as the potential effects of treatment on contraceptive effectiveness and overall health 1.
From the FDA Drug Label
If you get pregnant while using Kyleena, you may have an ectopic pregnancy... How will Kyleena change my periods? For the first 3 to 6 months, your period may become irregular and the number of bleeding days may increase. Changes in bleeding. You may have bleeding and spotting between menstrual periods, especially during the first 3–6 months.
The treatment options for perimenopausal irregular uterine bleeding are not explicitly mentioned in the provided drug labels. However, Kyleena (levonorgestrel intrauterine device) may be used to manage irregular uterine bleeding, as it can alter bleeding patterns.
- Bleeding patterns may become irregular and the number of bleeding days may increase during the first 3-6 months of use.
- Amenorrhea may ensue after prolonged use. It is essential to consult a healthcare provider to determine the best course of treatment for perimenopausal irregular uterine bleeding, as the provided information is not directly related to this specific condition 2 2.
From the Research
Treatment Options for Perimenopausal Irregular Uterine Bleeding
The treatment options for perimenopausal irregular uterine bleeding can be divided into several categories, including:
- Medical management: This includes the use of hormonal treatments such as oral progestogens, combined oral contraceptives, or the insertion of the levonorgestrel intrauterine system 3, 4, 5.
- Non-hormonal treatments: These include antifibrinolytic and non-steroidal anti-inflammatory drugs, which can help reduce the amount of bleeding 4, 5.
- Surgical options: These include endometrial ablation, endometrial resection, and hysterectomy, which may be necessary in some cases to treat abnormal uterine bleeding in perimenopause 6, 4.
Evaluation and Diagnosis
Before starting treatment, it is essential to evaluate and diagnose the cause of the abnormal uterine bleeding. This can be done through:
- Transvaginal ultrasound: This is an ideal first step for the evaluation of perimenopausal abnormal uterine bleeding 4.
- Saline or gel contrast sonohysterography: This can improve the diagnostic accuracy of transvaginal ultrasound 4.
- Endometrial biopsy or hysteroscopy: These invasive procedures can be planned based on the ultrasound findings to rule out premalignant and malignant causes 6, 4.
Specific Treatment Options
Some specific treatment options for perimenopausal irregular uterine bleeding include:
- Levonorgestrel-releasing intrauterine system: This is an effective treatment for menorrhagia and can also help reduce the amount of bleeding 6, 4, 5.
- Oral progesterone: This can be used to regulate menstrual cycles and reduce bleeding 6.
- Tranexamic acid: This is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive 6.
- Combined oral contraceptives: These can help regulate menstrual cycles and reduce bleeding, and also provide effective contraception 3.