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Suggested oral progestin/progesterone-only regimens for the acute management of anovulatory uterine bleeding and maintenance therapy after acute bleeding is controlled

Suggested oral progestin/progesterone-only regimens for the acute management of anovulatory uterine bleeding and maintenance therapy after acute bleeding is controlled
Preferred regimen for acute management*
Norethindrone acetate 5 or 10 mg orally nightly until bleeding stops and anemia resolves
Preferred maintenance regimens
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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