Nonpregnant reproductive-age patient with non-acute AUB: Initial management

AUB: abnormal uterine bleeding; NSAIDs: nonsteroidal antiinflammatory drugs; IUD: intrauterine device; LNG 52: 52 mg levonorgestrel-releasing IUD (Mirena or Liletta).

* Treatment of certain underlying conditions before initiating other therapy, if feasible, may correct the AUB or make further treatment more effective.

¶ Other progestin therapies (eg, DMPA, LNG 52) are not appropriate for treating patients with AUB who may wish to conceive in the next one to two years. NSAIDs may be used as an alternative, but should be discontinued upon conception.

Δ Estrogen therapy is contraindicated in some patients (eg, hypertension, history of venous thromboembolism or stroke, migraine with aura). This is discussed in related UpToDate content.

◊ While the LNG 52 is often appropriate for patients with contraindications to estrogen, some patients may decline, or have contraindications (eg, abnormalities of the uterine cavity, active pelvic infection) to the LNG 52. Treatment of such patients may include oral/injectable progestin therapy, noncontraceptive doses of estrogen-progestin therapy, or nonhormonal therapy (eg, NSAIDs, short-term use of tranexamic acid). Medical consultation is often helpful to determine thrombotic risk in selected patients. This is discussed in related UpToDate content.

§ High-dose oral or injectable progestin-only therapies may be used as an alternative to estrogen-progestin contraceptives or LNG 52 for selected patients; however, they often initially result in irregular menses and are associated with side effects (eg, dysphoria, bloating, increased appetite) that some patients find bothersome.

¥ Both estrogen-progestin contraceptives and the LNG 52 are effective treatments for AUB, provide effective contraception, are well tolerated, and have a low risk of adverse effects. The choice between the two methods depends on several factors (eg, patient preference) and is discussed in related UpToDate content.