Dysfunctional uterine bleeding medical therapy

Dysfunctional uterine bleeding Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Dysfunctional uterine bleeding from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Dysfunctional uterine bleeding medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Dysfunctional uterine bleeding medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Dysfunctional uterine bleeding medical therapy
CDC on Dysfunctional uterine bleeding medical therapy
Dysfunctional uterine bleeding medical therapy in the news
Blogs on Dysfunctional uterine bleeding medical therapy
Directions to Hospitals Treating Dysfunctional uterine bleeding
Risk calculators and risk factors for Dysfunctional uterine bleeding medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S, Vishnu Vardhan Serla M.B.B.S. [2]

Overview

The treatment for dysfunctional uterine bleeding has often proven to be successful but it is important to consider underlying etiologies, desire for fertility as well as any other symptoms patients may be experiencing. Treatment should be tailored for patients according to these underlying factors. The primary modality of treatment is hormonal, but there are nonhormonal options as well. It is important to treat acute bleeding as it may be life-threatening. Hormonal medications must be avoided in elderly women due to the risk of endometrial hyperplasia and malignancy. Iatrogenic causes should focus on treating the underlying causes.

Treatment

Management of dysfunctional uterine bleeding predominantly consists of reassurance, though mid-cycle estrogen and late-cycle progestin can be used for mid- and late-cycle bleeding respectively. An alternative option includes non-specific hormonal therapy such as combined estrogen and progestin can be given. The goal of therapy should be to arrest bleeding, replace lost iron to avoid anemia, and prevent future bleeding.

General treatment goals:

• Treat acute life-threatening bleeding
• Treatment of underlying etiologies
• Pain control with NSAIDs
• Menorrhagia control with levonorgestrel intrauterine contraceptive device

Pharmacotherapy:

Medical therapy has often proven to be successful. In cases of acute DUB and excessive blood loss, Tranexamic acid should be administered, as well as fluids if required.

Hormonal

• Oral contraceptives are used to treat non-acute bleeding.

  • Cyclic progesterone and Injectable progestins
  • Estrogen and progesterone
  • GnRH agonists

Non-hormonal

• Fibrinolytic agents
• Danazol
• Megestrol
• GnRH analogs (Gonadotropin-releasing hormone)
• Intrauterine progesterone
• Desmopressin; if DUB is due to vWF

Mechanical Options:

• Tamponade with foley bulb

Contraindicated medications:

Hormonal medications should generally be avoided in elder women. Uterine bleeding is considered an absolute contraindication for norelgestromin and ethinyl estradiol.