| 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
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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
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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
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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
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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
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NSAIDs
Naproxen Ibuprofen Mefenamic acid
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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
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Antifibrinolytics
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Provides symptomatic treatment only Does not address underlying cause Avoid in patients with past history of VTE
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Other agents
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