Version July 2025
AUB: abnormal uterine bleeding; DMPA: depot medroxyprogesterone acetate; LNG 52 mg IUD: 52 mg levonorgestrel-releasing intrauterine device; MPA: medroxyprogesterone acetate; NETA: norethindrone acetate; NSAIDs: nonsteroidal anti-inflammatory drugs; TXA: tranexamic acid.
* Treatment of certain underlying conditions before initiating other therapy, if feasible, may correct the AUB or make further treatment more effective.
¶ The choice between methods depends on several factors and is summarized in the table. A combination of methods can sometimes be used.
Δ LNG 52 is typically not used in those planning to conceive in the near future. The LNG 52 is also not used in patients with certain abnormalities of the uterine cavity or active pelvic infection.
◊ NSAIDs are options for some patients with heavy bleeding, but are generally avoided in individuals receiving an anticoagulant or with concern for a bleeding disorder, as they may worsening bleeding in such patients.
§ In addition to current or history of intrinsic thromboembolism, estrogen therapy is also contraindicated in patients with stroke, hypertension, migraine with aura, and certain cancers (eg, breast). This is discussed in related UpToDate content.
¥ Oral (eg, NETA, MPA) or injectable (DMPA) progestin-only therapies may be used as a reasonable alternative to estrogen-progestin contraceptives and LNG 52; however, they often initially result in irregular menses and bothersome side effects (eg, dysphoria, bloating, increased appetite). DMPA is also not an option for patients who may wish to conceive in the next one to two years.
‡ Medical consultation with a hematologist is often helpful to help determine the patient's individual risk of thrombosis.
† TXA is an antifibrinolytic agent that is an option for some patients with heavy bleeding (with or without a bleeding disorder).