Hormonal Management of Abnormal Uterine Bleeding

Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding

“…Others rapidly picked up the term, and it has been used extensively throughout the English-language literature since, often without being precisely defined and covering widely differing circumstances (Table 6) (67,70,71,82,86,(100)(101)(102)(103)(104)(105)(106)(107). In the USA, the term ''dysfunctional uterine bleeding'' has been used predominantly to describe irregular and presumed anovulatory uterine bleeding (57,65,85,86).…”

Noncontraceptive Uses of Hormonal Contraception

“…Anovulatory bleeding is usually irregular and unpredictable, variable in amount and duration, and most often observed in adolescents and perimenopausal women as well as in obese women and those with polycystic ovary syndrome 10 . It is important to note that women with endometrial hyperplasia or adenocarcinoma often have a history of anovulation with long‐term unopposed estrogen exposure, emphasizing the importance of evaluating and treating women with this condition.…”

Estrogen-Based Therapy for Acute Dysfunctional Uterine Bleeding

“…Estrogen-based therapy helps to control acute bleeding episodes by promoting rapid growth of the endometrium over areas that have become denuded and by stabilizing blood vessels. 2,4 When bleeding is severe and results in hypovolemia (e.g., hypotension or tachycardia) or shock, treatment with intravenous conjugated estrogens and fluids is generally carried out in the hospital setting. 6 Once the bleeding is controlled (generally within 24 to 48 hours), patients are normally switched to oral conjugated estrogens.…”

“…Hemodynamically stable patients with less severe bleeding may be managed initially with oral estrogen therapy, given either as conjugated estrogens or monophasic combination oral contraceptives. 4,6 As with intravenous therapy, a significant decrease in uterine bleeding normally occurs within 24 hours. 7…”

“…The control of recurrent DUB episodes can be achieved with a variety of agents, including progestins, combined estrogen/progestin therapy, danazol, and gonadotropin-releasing hormone analogues. 4 Acute, heavy DUB episodes are generally treated with estrogen-based therapies, 2 which will be the focus of this article.…”