Treatment options for HMB
| . | Agent . | Examples . | Mechanism . | Contraception . | Dosing . | Contraindications . | Amenorrhea rate . | Additional information . |
|---|---|---|---|---|---|---|---|---|
| Nonhormonal | Nonsteroidal anti-inflammatories | Ibuprofen, naproxen, mefenamic acid | Cyclo-oxygenase inhibition, decreased prostaglandins | No | • Varies | Allergic reaction, gastrointestinal disease, renal disease, some bleeding disorders | N/A | May benefit dysmenorrhea. |
| TXA | ——- | Reversibly blocks lysine-binding sites on plasminogen, slows fibrin degradation, stabilized clots | No | • 1300 mg 3 times daily for 5 days | Thromboembolic disease, defective color vision | N/A | ||
| Combined hormonal | COCs | Multiple | Suppresses endogenous estrogen production, thins uterine lining | Yes | • Varies, daily administration | Thromboembolic disease, migraine with aura, hypertension, breast cancer, liver disease, smokers >35 y of age | 79-88% at 12 cycles | Can take for extended duration. May benefit dysmenorrhea and/or acne. |
| Transdermal contraceptive patch | Xulane | Yes | • 120 µg levonorgestrel and 30 µg EE • 150 µg norelgestromin and 35 µg EE • Weekly patch change | No specific data; good with prolonged use | May benefit dysmenorrhea and/or acne. Not recommended for body mass index >30 or weight >198 lbs due to decreased efficacy. | |||
| Vaginal contraceptive ring | Nuvaring | Yes | • 120 µg etonogestrel and 15 µg EE (1 cycle) • 150 µg segesterone acetate and 13 µg EE (reuse for 13 cycles) • Monthly maintenance | Up to 89% at 6 mo | Easy extended use. May benefit dysmenorrhea and/or acne. May have less nausea compared to oral and transdermal. | |||
| Progesterone-only hormonal | Cyclic oral progesterone | Medroxyprogesterone acetate, norethindrone acetate | Thins uterine lining, decreased angiogenesis | No | • MPA 5-20 mg/d • NA 5-15 mg/d during luteal phase (cycle days 15-19 through 23-26) | Breast cancer, liver disease | N/A | |
| Continuous oral progesterone | Medroxyprogesterone acetate, norethindrone acetate | Thins uterine lining, may suppress endogenous estrogen production | No | • MPA 5-20 mg/d in 1-3 divided doses • NETA 5-15 mg/d in 1-3 divided doses | Up to 76% at 2 y | |||
| POPS | Norethindrone, Slynd, Opill | Thins uterine lining, may suppress endogenous estrogen production | Yes | • 35 µg norethindrone daily • 4 mg drosperinone daily • 75 µg norgestrel daily | No specific data; low for lower-dose pills | |||
| Progesterone-only injectable contraceptive | Depot medroxyprogesterone acetate | Thins uterine lining, suppresses endogenous estrogen production | Yes | • 150 mg intramuscular MPA every 3 mo • 104 mg SC MPA every 3 mo | 50% at 1 y; 68-71% at 2 y | Significant side effects of weight gain and potential exacerbation of mood symptoms. Reversible bone density loss limits duration of therapy. Intermediate thrombosis risk. | ||
| Progesterone-only contraceptive implant | Nexplanon | Thins uterine lining, may suppress endogenous estrogen production | Yes | • 68 mg etonogestrel | 22% | |||
| Progesterone-only IUS | Levonorgestrel | Thins uterine lining | Yes | • 20 µg/d • 17.5 µg/d • 14 µg/d | 50% at 1 y; 60% at 2 y | Contraindicated for uterine anomalies, active PID or active lower genital tract STI. |
| . | Agent . | Examples . | Mechanism . | Contraception . | Dosing . | Contraindications . | Amenorrhea rate . | Additional information . |
|---|---|---|---|---|---|---|---|---|
| Nonhormonal | Nonsteroidal anti-inflammatories | Ibuprofen, naproxen, mefenamic acid | Cyclo-oxygenase inhibition, decreased prostaglandins | No | • Varies | Allergic reaction, gastrointestinal disease, renal disease, some bleeding disorders | N/A | May benefit dysmenorrhea. |
| TXA | ——- | Reversibly blocks lysine-binding sites on plasminogen, slows fibrin degradation, stabilized clots | No | • 1300 mg 3 times daily for 5 days | Thromboembolic disease, defective color vision | N/A | ||
| Combined hormonal | COCs | Multiple | Suppresses endogenous estrogen production, thins uterine lining | Yes | • Varies, daily administration | Thromboembolic disease, migraine with aura, hypertension, breast cancer, liver disease, smokers >35 y of age | 79-88% at 12 cycles | Can take for extended duration. May benefit dysmenorrhea and/or acne. |
| Transdermal contraceptive patch | Xulane | Yes | • 120 µg levonorgestrel and 30 µg EE • 150 µg norelgestromin and 35 µg EE • Weekly patch change | No specific data; good with prolonged use | May benefit dysmenorrhea and/or acne. Not recommended for body mass index >30 or weight >198 lbs due to decreased efficacy. | |||
| Vaginal contraceptive ring | Nuvaring | Yes | • 120 µg etonogestrel and 15 µg EE (1 cycle) • 150 µg segesterone acetate and 13 µg EE (reuse for 13 cycles) • Monthly maintenance | Up to 89% at 6 mo | Easy extended use. May benefit dysmenorrhea and/or acne. May have less nausea compared to oral and transdermal. | |||
| Progesterone-only hormonal | Cyclic oral progesterone | Medroxyprogesterone acetate, norethindrone acetate | Thins uterine lining, decreased angiogenesis | No | • MPA 5-20 mg/d • NA 5-15 mg/d during luteal phase (cycle days 15-19 through 23-26) | Breast cancer, liver disease | N/A | |
| Continuous oral progesterone | Medroxyprogesterone acetate, norethindrone acetate | Thins uterine lining, may suppress endogenous estrogen production | No | • MPA 5-20 mg/d in 1-3 divided doses • NETA 5-15 mg/d in 1-3 divided doses | Up to 76% at 2 y | |||
| POPS | Norethindrone, Slynd, Opill | Thins uterine lining, may suppress endogenous estrogen production | Yes | • 35 µg norethindrone daily • 4 mg drosperinone daily • 75 µg norgestrel daily | No specific data; low for lower-dose pills | |||
| Progesterone-only injectable contraceptive | Depot medroxyprogesterone acetate | Thins uterine lining, suppresses endogenous estrogen production | Yes | • 150 mg intramuscular MPA every 3 mo • 104 mg SC MPA every 3 mo | 50% at 1 y; 68-71% at 2 y | Significant side effects of weight gain and potential exacerbation of mood symptoms. Reversible bone density loss limits duration of therapy. Intermediate thrombosis risk. | ||
| Progesterone-only contraceptive implant | Nexplanon | Thins uterine lining, may suppress endogenous estrogen production | Yes | • 68 mg etonogestrel | 22% | |||
| Progesterone-only IUS | Levonorgestrel | Thins uterine lining | Yes | • 20 µg/d • 17.5 µg/d • 14 µg/d | 50% at 1 y; 60% at 2 y | Contraindicated for uterine anomalies, active PID or active lower genital tract STI. |
EE, ethinylestradiol; MPA, medroxyprogesterone acetate; NETA, norethisterone acetate; PID, pelvic inflammatory disease; SC, subcutaneous; STI, sexually transmitted infection.