Dysfunctional uterine bleeding medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Dysfunctional uterine bleeding}} | {{Dysfunctional uterine bleeding}} | ||
{{CMG}} {{AE}} [[User:AroojNaz|Arooj Naz]], {{VVS}} | {{CMG}}; {{AE}}[[User:AroojNaz|Arooj Naz, M.B.B.S]], {{VVS}} | ||
==Overview== | ==Overview== | ||
The treatment for dysfunctional uterine bleeding has often proven to be successful but it is important to | 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 [[Endometrial cancer|malignancy]]. [[Iatrogenic]] causes should focus on treating the underlying causes. | ||
==Treatment== | ==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 [[hormone|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. | 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 [[hormone|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.<ref name="pmid30422508">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref><ref name="pmid304225084">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref> | ||
General treatment goals: | General treatment goals: | ||
*Treat acute life-threatening | *Treat acute life-threatening bleeding | ||
*Treatment of underlying etiologies | *Treatment of underlying etiologies | ||
*Pain control with NSAIDs<ref name="pmid15117012">{{cite journal| author=Albers JR, Hull SK, Wesley RM| title=Abnormal uterine bleeding. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 8 | pages= 1915-26 | pmid=15117012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15117012 }}</ref> | *Pain control with [[NSAIDs]]<ref name="pmid15117012">{{cite journal| author=Albers JR, Hull SK, Wesley RM| title=Abnormal uterine bleeding. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 8 | pages= 1915-26 | pmid=15117012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15117012 }}</ref> | ||
*Menorrhagia control with levonorgestrel intrauterine contraceptive device<ref name="pmid151170122">{{cite journal| author=Albers JR, Hull SK, Wesley RM| title=Abnormal uterine bleeding. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 8 | pages= 1915-26 | pmid=15117012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15117012 }}</ref> | *Menorrhagia control with [[Levonorgestrel IUD|levonorgestrel intrauterine contraceptive device]]<ref name="pmid151170122">{{cite journal| author=Albers JR, Hull SK, Wesley RM| title=Abnormal uterine bleeding. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 8 | pages= 1915-26 | pmid=15117012 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15117012 }}</ref> | ||
===Pharmacotherapy:=== | ===Pharmacotherapy:=== | ||
Medical therapy has often proven to be successful. In cases of acute DUB and excessive blood loss, Tranexamic acid | 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'' | ''Hormonal'' | ||
*Oral contraceptives are used to treat | *[[Oral contraceptives]] are used to treat non-acute bleeding. | ||
*:*Cyclic progesterone and Injectable progestins | *:*[[Cyclic progesterone]] and [[Injectable progestins]] | ||
*:*Estrogen | *:*[[Estrogen]] and [[progesterone]] | ||
*:*GnRH agonists | *:*[[GnRH agonists]] | ||
''Non-hormonal'' | ''Non-hormonal'' | ||
*Fibrinolytic agents | *[[Fibrinolytic]] agents | ||
*Danazol | *[[Danazol]] | ||
*Megestrol | *[[Megestrol]] | ||
*GnRH analogs (Gonadotropin-releasing hormone) | *[[GnRH analogs]] ([[Gonadotropin-releasing hormone]]) | ||
*Intrauterine progesterone | *[[Intrauterine progesterone]] | ||
*Desmopressin; if DUB is due to vWF<ref name="pmid304225083">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref> | *[[Desmopressin]]; if DUB is due to [[vWF]]<ref name="pmid304225083">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref> | ||
'''Mechanical Options:''' | '''Mechanical Options:''' | ||
*Tamponade with foley bulb<ref name="pmid304225082">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref> | *Tamponade with [[foley bulb]]<ref name="pmid304225082">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30422508 | doi= | pmc= | url= }}</ref> | ||
===Contraindicated medications:=== | ===Contraindicated medications:=== | ||
Hormonal medications should generally be avoided in elder women.<ref name="pmid2692922">{{cite journal| author=Cameron IT| title=Dysfunctional uterine bleeding. | journal=Baillieres Clin Obstet Gynaecol | year= 1989 | volume= 3 | issue= 2 | pages= 315-27 | pmid=2692922 | doi=10.1016/s0950-3552(89)80024-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2692922 }}</ref> Uterine bleeding is considered an absolute contraindication for norelgestromin and ethinyl estradiol. | Hormonal medications should generally be avoided in elder women.<ref name="pmid2692922">{{cite journal| author=Cameron IT| title=Dysfunctional uterine bleeding. | journal=Baillieres Clin Obstet Gynaecol | year= 1989 | volume= 3 | issue= 2 | pages= 315-27 | pmid=2692922 | doi=10.1016/s0950-3552(89)80024-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2692922 }}</ref> [[Uterine bleeding]] is considered an absolute contraindication for [[Norelgestromin and ethinyl estradiol transdermal system|norelgestromin and ethinyl estradiol]]. | ||
<br /> | <br /> | ||
==References== | ==References== | ||
Latest revision as of 01:25, 7 August 2022
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Dysfunctional uterine bleeding Microchapters |
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Differentiating Dysfunctional uterine bleeding from other Diseases |
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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.[1][2]
General treatment goals:
- Treat acute life-threatening bleeding
- Treatment of underlying etiologies
- Pain control with NSAIDs[3]
- Menorrhagia control with levonorgestrel intrauterine contraceptive device[4]
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.
Non-hormonal
- Fibrinolytic agents
- Danazol
- Megestrol
- GnRH analogs (Gonadotropin-releasing hormone)
- Intrauterine progesterone
- Desmopressin; if DUB is due to vWF[5]
Mechanical Options:
- Tamponade with foley bulb[6]
Contraindicated medications:
Hormonal medications should generally be avoided in elder women.[7] Uterine bleeding is considered an absolute contraindication for norelgestromin and ethinyl estradiol.
References
- ↑ "StatPearls". ( ). 2022: . PMID 30422508.
- ↑ "StatPearls". ( ). 2022: . PMID 30422508.
- ↑ Albers JR, Hull SK, Wesley RM (2004). "Abnormal uterine bleeding". Am Fam Physician. 69 (8): 1915–26. PMID 15117012.
- ↑ Albers JR, Hull SK, Wesley RM (2004). "Abnormal uterine bleeding". Am Fam Physician. 69 (8): 1915–26. PMID 15117012.
- ↑ "StatPearls". ( ). 2022: . PMID 30422508.
- ↑ "StatPearls". ( ). 2022: . PMID 30422508.
- ↑ Cameron IT (1989). "Dysfunctional uterine bleeding". Baillieres Clin Obstet Gynaecol. 3 (2): 315–27. doi:10.1016/s0950-3552(89)80024-0. PMID 2692922.