What medications can be used to induce menstruation (menses)?

From the Guidelines

Hormonal treatment with low-dose COCs or estrogen for short-term treatment (10–20 days) is the recommended medication to start a period, as per the 2013 U.S. Selected Practice Recommendations for Contraceptive Use 1. When considering medications to induce menstruation, it's essential to rule out underlying gynecological problems, such as interactions with other medications, STDs, pregnancy, or new pathologic uterine conditions, as suggested by the 2013 U.S. Selected Practice Recommendations for Contraceptive Use 1. Some key points to consider when choosing a medication to start a period include:

• NSAIDS for short-term treatment (5–7 days) may be considered for irregular bleeding, but they are not specifically used to induce menstruation 1
• Hormonal treatment, such as low-dose COCs or estrogen, is a viable option for short-term treatment (10–20 days) to induce menstruation, if medically eligible 1
• It's crucial to counsel women on alternative methods and offer another method if the chosen treatment is not effective or acceptable 1 Before initiating any medication, it's vital to assess the woman's medical eligibility and ensure that she is not pregnant, as hormonal treatments can have adverse effects in these situations. In clinical practice, the primary goal is to address the underlying cause of the delayed period, rather than just inducing menstruation, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

Progesterone capsules are used for the treatment of secondary amenorrhea (absence of menstrual periods in women who have previously had a menstrual period) due to a decrease in progesterone When you do not produce enough progesterone, menstrual irregularities can occur. If your healthcare provider has determined your body does not produce enough progesterone on its own, progesterone capsules may be prescribed to provide the progesterone you need In a single-center, randomized, double-blind clinical study that included premenopausal women with secondary amenorrhea for at least 90 days, administration of 10 days of progesterone capsules therapy resulted in 80 percent of women experiencing withdrawal bleeding within 7 days of the last dose of progesterone capsules, 300 mg per day (n=20), compared to 10 percent of women experiencing withdrawal bleeding in the placebo group (n=21)

Medications to start period:

• Progesterone capsules may be prescribed to provide the progesterone needed to start a period in women with secondary amenorrhea due to a decrease in progesterone.
• The typical dosage is 400 mg at bedtime for 10 days 2.
• In clinical studies, 80% of women with secondary amenorrhea experienced withdrawal bleeding within 7 days of the last dose of progesterone capsules, 300 mg per day 2.
• It is essential to consult a healthcare provider to determine the best course of treatment for individual cases of secondary amenorrhea.

From the Research

Medications to Induce Menstruation

Medications can be used to induce menstruation in women with amenorrhea, depending on the underlying cause.

• For women with hyperprolactinemic amenorrhea, prolactin-lowering drugs can be used to induce fertility and menstruation 3.
• For women with hypogonadotropic amenorrhea, pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropins can be used to induce ovulation and menstruation 3.
• For women with normogonadotropic amenorrhea, cyclical progestogen administration or the sequential use of estrogen plus progestogen can be used to induce menstrual bleeding 3.
• Progestin-only contraceptives can be used to induce menstruation in women with contraindications to estrogen 4.
• Hormonal therapy, including estrogen and progesterone, can be used to induce menstruation in women with hypoestrogenic amenorrhea 5.

Treatment Options

Treatment options for amenorrhea depend on the underlying cause and may include:

• Hormone replacement therapy (HRT) to regulate the menstrual cycle and prevent estrogen deficiency 3.
• Oral contraception to ensure contraception and regulate the menstrual cycle 3, 4.
• Prolactin-lowering drugs to induce fertility and menstruation in women with hyperprolactinemic amenorrhea 3.
• GnRH or gonadotropins to induce ovulation and menstruation in women with hypogonadotropic amenorrhea 3.
• Cyclical progestogen administration or the sequential use of estrogen plus progestogen to induce menstrual bleeding in women with normogonadotropic amenorrhea 3.