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تعداد آیتم قابل مشاهده باقیمانده : 1 مورد

Nonpregnant reproductive-age patients with HMB: Advantages and disadvantages of frequently used medical treatment options

Nonpregnant reproductive-age patients with HMB: Advantages and disadvantages of frequently used medical treatment options
  Advantages Disadvantages
COCs
  • Reduces dysmenorrhea
  • Reduces the risk of endometrial and ovarian cancer
  • Provides contraception
  • Requires daily administration
  • Increased VTE risk (risk varies with estrogen dose and patient factors such as age, body mass index, and smoking status)
  • Increased risks of hypertension, myocardial infarction, and stroke in certain populations
LNG 52 mg IUD (Mirena or Liletta)
  • Does not increase VTE or cardiovascular disease risk
  • Does not require daily therapy
  • Reduces dysmenorrhea
  • Reduces risk of endometrial, cervical, and ovarian cancer
  • Provides contraception
  • Requires a procedure for insertion and removal
  • May not be cost effective for those who are planning to conceive in the near future
  • Contraindicated in patients with certain abnormalities of the uterine cavity or active pelvic infection
TXA
  • Only taken during menstruation/bleeding
  • Can be used in some patients with contraindications to hormonal therapy (eg, personal history of breast cancer)
  • Does not provide contraception
  • Does not treat dysmenorrhea
  • Contraindicated in those with active thrombosis, history of thrombosis, or taking combined hormonal contraception*
NSAIDs
  • Reduces dysmenorrhea
  • Available over the counter
  • May be taken only during menstruation
  • Does not provide contraception
  • May worsen bleeding in some patients (eg, those on anticoagulant therapy; concern for a bleeding disorder)

For patients with HMB and no known structural, infectious, or endocrine etiology, initial treatment options include COCs, LNG 52 mg IUD, TXA, and NSAIDs. The choice of therapy depends on several factors (eg, bleeding severity, patient preferences, comorbidities, need for contraception). For patients who cannot or choose not to use one of these methods, reasonable alternatives include other progestin-therapies (eg, oral progestins, DMPA) and noncontraceptive doses of estrogen-progestin; surgical interventions (eg, endometrial ablation, hysterectomy) are also options for patients who have completed childbearing. These options are discussed in related UpToDate content.

Some therapies (eg, COCs or LNG 52 IUD plus NSAIDs) may be used concurrently.

COCs: combination oral contraceptives; DMPA: depot medroxyprogesterone acetate; HMB: heavy menstrual bleeding; LNG 52 mg IUD: 52 mg levonorgestrel-releasing intrauterine device; NSAIDs: nonsteroidal anti-inflammatory drugs; TXA: tranexamic acid; VTE: venous thromboembolism.

* Some experts consider concomitant use of TXA and COCs to be reasonable in patients with a bleeding disorder (eg, von Willebrand disease), or those in whom additional thrombosis risk factors (eg, obesity, immobility) are not present.
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