Table 1.

Drug therapy options for AUB

Hormonal options
  • Can be used for prevention and treatment of AUB

  • Decreases the likelihood of unscheduled or prolonged and heavy bleeding episodes

  • Good option for women who desire reliable contraception


  • Decreases menstrual blood loss by 86% at 3 mo and 97% at 12 mo; 20%–80% of patients are amenorrheic at 1 y

  • Only has to be inserted every 5 y

  • Most effective option in obese and overweight women

  • Avoid in patients with breast cancer or those with recurrent or recent PID

  • Use with caution in immunocompromised patients or those at high risk of STI

  • COCs

  • Decreases menstrual blood loss by 40%–50%

  • Select a COC with ≥ 30 µg of ethinyl estradiol

  • Dosing is continuous or cyclic

  • Avoid in patients with history of stroke or VTE, uncontrolled HTN, migraine with neurologic symptoms, breast cancer, or active liver disease

  • DMPA

  • 60%–70% of patients become amenorrheic after first y

  • Doses administered every 12 wk

  • Avoid in patients with breast cancer, active liver disease, or liver tumours

  • Progestin-only pills

  • 50% of women achieve cyclic regularity

  • 10 mg/d of medroxyprogesterone from cycle d 5–26 (21 d) or 100 mg/d of micronized progesterone from d 14–28 (luteal phase)

  • Avoid in patients with breast cancer or liver disease

  • Naproxen

  • Ibuprofen

  • Mefenamic acid

  • Decreases prostaglandin production to promote uterine vasoconstriction and decrease bleeding

  • Can be taken safely with oral contraceptives for dysmenorrhea treatment

  • Recommend starting the day before menses and continuing for 3–5 d or until bleeding stops

  • No evidence that one NSAID is better than another; cost varies

  • Avoid in patients with platelet or coagulation disorders, peptic ulcer disease, and pre-existing gastritis

  • Tranexamic acid

  • Provides symptomatic treatment only

  • Does not address underlying cause

  • Avoid in patients with past history of VTE

Other agents
  • Danazol

  • Gonadotropin-releasing hormone agonists

  • Ulipristal

  • Usually to be used in consultation with a gynecologist or other specialist

  • Used as second-line agents

  • AUB—abnormal uterine bleeding, COC—combined oral contraceptive, DMPA—depot medroxyprogesterone acetate, HTN—hypertension, LNG-IUS—levonorgestrel intrauterine system, NSAID—nonsteroidal anti-inflammatory drug, PID—pelvic inflammatory disease, STI—sexually transmitted infection, VTE—venous thromboembolism.

  • Data from Towriss.6