A young woman presents with dysfunctional uterine bleeding. Exam is unremarkable and she has no concerning medical history. She has not symptoms of anemia. She asks about medications to control the symptoms.
Oral Progestin (board answer) – ACOG suggests medroxyprogesterone acetate 20 mg TID for 7 days. This regimen usually stops bleeding in a median of 3 days for 76% of women.
NSAIDS (new answer) – NSAIDs have been shown to reduce bleeding by up to 50%. Cochrane review showed no difference from placebo however as these drugs are widely available and usually safe they should be considered in non-pregnant women with DUB.
Antifibrinolytics (maybe future answer) – TXA (tranexamic acid) has been used in Europe but not the US. Cochrane review showed antifibrinolytics were superior to progesterone / nsaids and placebo. These drugs appear safe but there is no evidence of safety with combined use of hormones.
Borhart, MD (2013) Emergency Department Management Of Vaginal Bleeding In The Nonpregnant Patient, Emergency Medicine Practice, Vol. 15 Num. 8. http://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=375&seg_id=6458
