Table 5.

Evidence-based assessment of hormonal therapy in patients with inherited bleeding disorders⁶⁸

Hormonal product	Efficacy	Other clinical factors
Levonorgestrel-releasing intrauterine system	Most effective therapy for heavy menstrual bleeding	Provides 5 yr of therapy Contraception failure rate < 0.1% Removal requested by patient in 17%–20% of cases Spontaneous expulsion rate 8% (decreased with associated use of tranexamic acid)
Combined hormonal contraception (birth control pill, transdermal patch and vaginal ring)	Effective for contraception and menses suppression	Can be used monthly or continuously for 12 mo Break-through bleeding can occur
Progesterone only (pill, intramuscular medroxyprogesterone or intradermal implant)	Reduces menstrual blood loss with irregular bleeding	—