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. 2011 Jan 3;127(2):347–357. doi: 10.1542/peds.2010-2221

TABLE 5.

Our Approach to Treatment Options and Hormone Therapies Amidst Thrombotic Risk

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.