Version July 2025
| Preferred regimen for acute management* | |
| Norethindrone acetate | 5 or 10 mg orally nightly¶ until bleeding stops and anemia resolves |
| Preferred maintenance regimens*Δ | |
| Oral micronized progesterone◊ | 200 mg orally nightly for the first 12 days of each calendar month§ |
| Norethindrone acetate | 5 mg orally nightly for the first 5 to 10 days of each calendar month§ |
| Alternative maintenance regimen* | |
| Medroxyprogesterone acetateΔ | 10 mg orally nightly for the first 10 days of each calendar month§ |
| Alternative maintenance regimens for patients desiring contraception | |
| Norethindrone | 0.35 mg orally daily; provides contraception if taken consistently |
| Drospirenone | 4 mg orally once daily for 24 days, followed by inactive pill once daily for 4 days |
| LNG IUD | 52 mg LNG IUD provides acute stabilization of bleeding and ongoing maintenance therapy |
| Depot medroxyprogesterone | 150 mg IM every 12 to 13 weeks |
IM: intramuscular; IUD: intrauterine device; LNG: levonorgestrel.
* Does not provide contraception.
¶ May be administered up to 4 times per day if acute bleeding is severe.
Δ We suggest starting cyclic oral progesterone on the first day of each calendar month because this is easier for adolescents to remember.
◊ Contains peanut oil.
§ If menstrual bleeding occurs while taking oral progesterone, discontinue for the remainder of the cycle and restart at the beginning of the following month.
