Treatment of Dysfungsion uterine bleeding

Emergency Department Care

See the list below:

Hemodynamically unstable patients with uncontrolled bleeding and signs of significant

blood loss should have aggressive resuscitation with saline and blood as with other types
of hemorrhagic shock.
o Evaluate ABCs and address the priorities.
o Initiate 2 large-bore intravenous lines (IVs), oxygen, and cardiac monitor.
o If bleeding is profuse and the patient is unresponsive to initial fluid management,
consider administration of IV conjugated estrogen (Premarin) 25 mg IV every 4-6
hours until the bleeding stops.
o In women with severe, persistent uterine bleeding, an immediate dilation and
curettage (D&C) procedure may be necessary.

Combination oral contraceptive pills may be used in women who are not pregnant and
have no anatomic abnormalities. An oral contraceptive with 35 mcg of ethinyl estradiol
can be taken twice a day until the bleeding stops for up to 7 days, at which time the dose
is decreased to once a day until the pack is completed. They provide the additional
benefits of reducing dysmenorrhea and providing contraception. Side effects include
nausea and vomiting.[3]

Progesterone alone can be used to stabilize an immature endometrium. It is usually

successful in the treatment of women with anovulatory dysfunctional uterine bleeding
(DUB) because these women have unopposed estrogen stimulation.
Medroxyprogesterone acetate 10 mg is taken orally once daily for 10 days, followed by
withdrawal bleeding 3-5 days after completion of the course. Currently, there is not
enough evidence comparing the effect of either progesterone alone or in combination
with estrogens for the treatment of dysfunctional uterine bleeding.[9]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally effective for the treatment
of dysfunctional uterine bleeding and dysmenorrhea. NSAIDs inhibit cyclooxygenase in
the arachidonic acid cascade, thus inhibiting prostaglandin synthesis and increasing
thromboxane A2 levels. This leads to vasoconstriction and increased platelet aggregation.
These medications may reduce blood loss by 20-50%. NSAIDs are most effective if used
with the onset of menses or just prior to its onset and continued throughout its duration.

Danazol creates a hypoestrogenic and hyperandrogenic environment, which induces

endometrial atrophy resulting in reduced menstrual loss. Side effects include
musculoskeletal pain, breast atrophy, hirsutism, weight gain, oily skin, and acne. Because
of the significant androgenic side effects, this drug is usually reserved as a second-line
treatment for short-term use prior to surgery.

Gonadotropin-releasing hormone agonists may be helpful for short-term use in inducing

amenorrhea and allowing women to rebuild their red blood cell mass. They produce a
profound hypoestrogenic state similar to menopause. Side effects include menopausal
symptoms and bone loss with long-term use.

Tranexamic acid is an antifibrinolytic drug that exerts its effects by reversibly inhibiting
plasminogen. It diminishes fibrinolytic activity within endometrial vessels to prevent
bleeding. It has been shown effective in reducing bleeding in up to half of women with
dysfunctional uterine bleeding. Tranexamic acid is not approved for the treatment of
dysfunctional uterine bleeding in the United States.[8]