TABLE 5.
Problem | First-Line Treatment | With Minor Thrombophilia (Obesity, Travel, Smoking) | With Major Thrombophilia (Surgery With Immobilization, Inherited Thrombophilia) | History of Thrombosis |
---|---|---|---|---|
Contraception | COC, DMPA, LNG-IUS, ETG | COC, POP, DMPA, LNG-IUS, ETG | POP, DMPA, LNG-IUS, ETG | POP, LNG-IUS, DMPA, ETG |
Dysmenorrhea | NSAID, COC | NSAID, COC | POP, DMPA | POP, DMPA |
DUB, mild or moderate | Cyclic progestin (MPA, NET), COC | Cyclic progestin (MPA, NET), COC | Cyclic or continuous progestin (NET) | Cyclic or continuous progestin (NET) |
DUB, severe | COC | COC | NET, GnRH-a with NET add-back; LNG-IUS | NET, GnRH-a with NET add-back, LNG-IUS |
Hypothalamic amenorrhea | Weight gain, nutrition, COC, transdermal E2 and progestin (NET, MPA) | COC, transdermal E2 and progestin (NET, MPA) | Transdermal E2 and progestin (NET, MPA) | Transdermal E2 and progestin (NET, MPA) |
Polycystic ovary syndrome (PCOS) | COC, lifestyle change, metformin | COC, POP, cyclic progestins, metformin | POP, cyclic progestins, metformin | POP, cyclic progestins, metformin |
Endometriosis | Continuous COC, NET, POP, DMPA, GnRH-a and add-back (estrogen/progestin or NET) | continuous COC, NET, POP, DMPA, GnRH-a and add-back (estrogen/progestin or NET) | GnRH-a and NET add-back, NET alone, DMPA | GnRH-a and NET add-back, NET alone, DMPA |
Primary ovarian insufficiency (POI) | Transdermal E2 and cyclic progestin (NET, MPA), COC | Transdermal E2 and cyclic progestin (NET, MPA), COC | Transdermal E2 and cyclic progestin (NET, MPA) | Transdermal E2 and cyclic progestin (NET, MPA) |
DMPA indicates depot medroxyprogesterone acetate; LNG-IUS, levonorgestrel intrauterine system; ETG, etonogestrel implant; POP, progestin only pills, norethindrone 0.35 mg/day; NSAID, nonsteroidal anti-inflammatory drug; MPA, oral medroxyprogesterone; NET indicates norethindrone 5 to 15 mg/day; GnRH-a, gonadotropin-releasing hormone agonist; E2, 17-β estradiol. In this table, COC includes the transdermal patch and vaginal ring.