NSAIDs
-
Mefenamic acid (250 mg) -
Naproxen (250–275 mg) -
Ibuprofen (200–400 mg) Dose: 1–2 tablets before or at beginning of menses, then 1 tablet every 6–8 h as required | Inhibit prostaglandin synthesis, might also alleviate menstrual pain
No evidence of difference in clinical efficacy of individual NSAIDs |
Antifibrinolytics:
Tranexamic acid (500 mg-1000 mg every 6–8 h as required | Counteract increased fibrinolytic activity, significantly reduce mean blood loss compared with placebo, NSAIDs (mefenamic acid), and oral luteal phase progestins (level I evidence) |
Combined oral contraceptives | Useful for anovulatory bleeding, might have benefit for ovulatory bleeding (although lack of good-quality data) |
Progestins
| Stabilizes endometrium
T-shaped intrauterine device releases a steady amount of levonorgestrel (20 μg/24 h), low level of circulating hormone minimizes systemic side effects, training in insertion is advised |
Androgens:
Danazol (200 mg once daily) | Inhibits steroidogenesis in ovaries
Side effects: androgenic (weight gain, acne, irritability, headaches, hirsutism, clitoromegaly, decreased breast size), lipid changes, liver disease, muscle cramps, breakthrough bleeding, gastrointestinal distress |
Gonadotropin-releasing hormone agonists
-
Leuprolide acetate (3.75 mg IM/mo or 11.25 mg IM/3 mo) -
Nafarelin (200 μg intranasally twice daily) -
Goserelin (3.6 mg sc/mo or 10.8 mg sc/3 mo)
| Induce a reversible hypoestrogenic state
Side effects: androgenic (see above), menopausal symptoms in 80%–90% of women (hot flashes, vaginal dryness, etc), irregular bleeding. Add-back therapy (cyclic estrogen and progestin similar to hormone replacement therapy) can minimize side effects |