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.
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