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. 2007 Jan;53(1):58–64.

Table 5.

Medical therapy for abnormal uterine bleeding in premenopausal and perimenopausal women

MEDICATION ACTION
NSAIDs

  • Mefenamic acid (250 mg)

  • Naproxen (250–275 mg)

  • Ibuprofen (200–400 mg)

Dose: 1–2 tablets before or at beginning of menses, then 1 tablet every 6–8 h as required		 Inhibit prostaglandin synthesis, might also alleviate menstrual pain
No evidence of difference in clinical efficacy of individual NSAIDs
Antifibrinolytics:
Tranexamic acid (500 mg-1000 mg every 6–8 h as required		 Counteract increased fibrinolytic activity, significantly reduce mean blood loss compared with placebo, NSAIDs (mefenamic acid), and oral luteal phase progestins (level I evidence)
Combined oral contraceptives Useful for anovulatory bleeding, might have benefit for ovulatory bleeding (although lack of good-quality data)
Progestins

  • Levonorgestrel intrauterine system

  • Oral progestins: medroxyprogesterone acetate (5–10 mg/d for 10–14 days initially and repeated for 10 days each month thereafter

 Stabilizes endometrium
T-shaped intrauterine device releases a steady amount of levonorgestrel (20 μg/24 h), low level of circulating hormone minimizes systemic side effects, training in insertion is advised
Androgens:
Danazol (200 mg once daily)		 Inhibits steroidogenesis in ovaries
Side effects: androgenic (weight gain, acne, irritability, headaches, hirsutism, clitoromegaly, decreased breast size), lipid changes, liver disease, muscle cramps, breakthrough bleeding, gastrointestinal distress
Gonadotropin-releasing hormone agonists

  • Leuprolide acetate (3.75 mg IM/mo or 11.25 mg IM/3 mo)

  • Nafarelin (200 μg intranasally twice daily)

  • Goserelin (3.6 mg sc/mo or 10.8 mg sc/3 mo)

 Induce a reversible hypoestrogenic state
Side effects: androgenic (see above), menopausal symptoms in 80%–90% of women (hot flashes, vaginal dryness, etc), irregular bleeding. Add-back therapy (cyclic estrogen and progestin similar to hormone replacement therapy) can minimize side effects

Adapted with permission from Bordman et al14 and MacGibbon and Jakubovicz.15

IM—intramuscularly, NSAIDs—nonsteroidal anti-inflammatory drugs, sc-subcutaneously.