Table 2. Pharmacological options for the treatment of acute and chronic abnormal uterine bleeding.

Medication	Regime	Efficiency
Combined oral contraceptives	Acute bleeding Contraceptives with ethinyl estradiol 30 mcg or 35 mcg 1 tablet/day, every 8 hours, for 7 days, followed by 1 tablet/day for 3 weeks. Chronic bleeding Combined oral, combined transdermal contraceptives or combined vaginal ring - all according to the package insert.	High
Oral progestogen	Acute bleeding Medroxyprogesterone acetate 20 mg, every 8 hours, for 7 days. Chronic bleeding Oral medroxyprogesterone acetate (2.5–10 mg), or norethisterone acetate (2.5–5 mg), or megestrol acetate (40-320 mg) at the dose recommended in the package insert, or micronized progesterone (200–400 mg), dydrogesterone (10 mg). No ovulatory dysfunction: 1 tablet/day from the 5th to 26th day of the cycle or continuously. With ovulatory dysfunction: adjust dose/day, use for 2 weeks every 4 weeks.	High
Levonorgestrel-releasing intrauterine system	Chronic bleeding Insert the levonorgestrel-releasing intrauterine system every 5 years, with release of 20 mcg/day.	High
Depot medroxyprogesterone acetate	Chronic bleeding 150 mg intramuscularly injected every 12 weeks.	Low/Moderate
Gonadotropin-releasing hormone analog	Chronic bleeding Leuprolide acetate (3.75 mg monthly or 11.25 mg quarterly) intramuscularly, or goserelin (3.6 mg monthly or 10.8 mg quarterly), or subdermal.	High
Non-steroidal anti-inflammatory drugs	Chronic bleeding Ibuprofen 600 to 800 mg, every 8 hours, or mefenamic acid 500 mg every 8 hours.	Moderate
Tranexamic acid	Chronic bleeding • Swedish Medical Products Agency (MPA): 1–1.5 g, 3 to 4 times a day orally, for 3 to 4 days (the dose may be increased for up to 1 g, 6 times a day). • European Medicines Agency (EMA): 1 g, 3 times a day, for 4 days (the dose may be increased, but respecting the maximum dose of 4 g per day). • US Food and Drug Administration (FDA): 1.3 g, 3 times a day, for up to 5 days, or 10 mg/kg intravenously (at a maximum dose of 600 mg/dose, every 8 hours, for 5 days [in cases of bleeding without structural lesion]).	High

Source: Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016; 214(1):31–44;21 Karakus S, Kiran G, Ciralik H. Efficacy of micronized vaginal progesterone versus oral dydrogesterone in the treatment of irregular dysfunctional uterine bleeding: A pilot randomized controled trial. Aust N Z J Obstet Gynaecol. 2009; 49(6):685–8;30 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013; 121(4):891–6.22