The medical management of abnormal uterine bleeding in reproductive-aged women

Am J Obstet Gynecol. 2016 Jan;214(1):31-44. doi: 10.1016/j.ajog.2015.07.044. Epub 2015 Aug 5.


In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention.

Keywords: International Federation of Gynecology and Obstetrics classification; abnormal uterine bleeding; heavy menstrual bleeding; medical treatment; premenopausal women.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticoagulants / adverse effects
  • Antifibrinolytic Agents / therapeutic use
  • Blood Coagulation Disorders, Inherited / complications
  • Contraceptives, Oral, Combined / therapeutic use
  • Contraceptives, Oral, Hormonal / therapeutic use
  • Danazol / therapeutic use
  • Estrogen Antagonists / therapeutic use
  • Estrogens / administration & dosage
  • Estrogens / therapeutic use*
  • Female
  • Gonadotropin-Releasing Hormone / agonists
  • Humans
  • Intrauterine Devices, Medicated
  • Leiomyoma / complications
  • Leiomyoma / drug therapy*
  • Menorrhagia / drug therapy*
  • Menorrhagia / etiology
  • Metrorrhagia / drug therapy*
  • Metrorrhagia / etiology
  • Progestins / administration & dosage
  • Progestins / therapeutic use*
  • Severity of Illness Index
  • Tranexamic Acid / therapeutic use
  • Uterine Neoplasms / complications
  • Uterine Neoplasms / drug therapy*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Antifibrinolytic Agents
  • Contraceptives, Oral, Combined
  • Contraceptives, Oral, Hormonal
  • Estrogen Antagonists
  • Estrogens
  • Progestins
  • Gonadotropin-Releasing Hormone
  • Tranexamic Acid
  • Danazol