Heavy Menstrual Bleeding Flashcards
Heavy Menstrual Bleeding
Treated with Estrogen-progestin contraceptives, monotherapy of either, Levonorgestrel Intrauterine Device, NSAIDs, TXA
E/P Contraceptives (Oral Contraceptives)
IND: First line for many pts
Reduce bleeding
Provides contraception
OC’s with less hormone-free intervals = less withdrawal bleeding
Estradiol Valerate-Dienogest
IND: HMB, contraception. The only FDA approved one.
MOA: Simulate endogenous progestin and estrogen. Quadriphasic.
BOX: Cigarette smoking and CV events; increased risk of CV events in women older than 35
CON: Breast cancer or other Neoplasms, hepatic tumors/diseases, pregnancy, undiagnosed abdominal uterine bleeding
ADR: HA
Conjugated Estrogen
IND: HMB, contraception, metastatic breast cancer, hypoestrogenism, osteoporosis prevention, prostate cancer, vasomotor s/s, vaginal atrophy
MOA: Acts as endogenous estrogen
BOX: Endometrial cancer; increased risk of unopposed estrogen (no progestin)
CV DZ
Breast cancer: Increased risk
Dementia: Not for prevention
CON: UnDx genital bleeding, thromboembolic dz, breast cancer, estrogen-dependent tumors, hepatic dz, pregnancy
ADR: Breast pain, vaginal bleeding, m/s pain
Levonorgestrel IntraUterine Device
Mirena and Liletta
IND: HMB, contraception
MOA: Acts as endogenous Progestin
BOX: n/a
CON: Pregnancy, postcoital contraception, uterine anomalies, PID, Postpartum endometritis, infected abortion, uterine/cervical malignancy, cervicitis or vaginitis, hepatic dz/tumors, breast/hormone related cancers
ADR: Amenorrhea, Ovarian cysts, bacterial vaginosis, Vaginal mycosis
A/w: less bleeding. 3 months spotting. 6 months amenorrhea
Progestin Only Agents
Pts who have CON to or prefer to avoid estrogen
High dose: trying for pregnancy
Medroxyprogesterone Acetate (Depo-Provera)
IND: Abnormal uterine bleeding and contraception
MOA: Acts as Progestin. Depot
BOX: Not for long term contraception; 2 years
Significant loss of bone mineral density
CON: Active thrombophlebitis/Thromboembolic disorders. Cerebral vascular dz, UnDx vaginal bleeding, breast cancer, hepatic dz, pregnancy
ADR: Amenorrhea, weight gain/loss, hot flashes
Medroxyprogesterone (Provera)
IND: Abnormal uterine bleeding
MOA: Acts as Progestin. Oral
BOX: Cardiovascular disorders
Breast cancer risk
Dementia; doesn’t prevent
CON: Thromboembolic disorders, E/P dependent tumors, hepatic dz, pregnancy, UnDx bleeding
ADR: Amenorrhea, weights, hot flashes
Norethindrone
IND: Abnormal uterine bleeding, contraception
MOA: Acts as Progestin. Oral. 5mg for bleeding. 0.35mg for contraception
BOX: n/a
CON: Thromboembolic disorders, breast cancer, hepatic dz, pregnancy, UnDx bleeding
ADR: Amenorrhea, weights, hot flashes
Relugolix, Estradiol, Norethindrone Acetate
IND: HMB bleeding
MOA: Acts as Progestin and estrogen. Decreases estradiol, progesterone, FSH/LH. Reduces bleeding a/w fibroids. Silly cause it contains estradiol to help reduce bone loss. Limited to 24 months of use.
BOX: Thromboembolic disorders
CON: UnDx bleeding, breast cancer, hormone sensitive cancer, osteoporosis, hepatic dz, pregnancy
ADR: Sweating excessively, increase cholesterol, hot flashes
Tranexamic Acid (TXA)
IND: HMB, a lot of other situations to prevent bleeding.
MOA: Inhibits fibrinolysis and proteolytic activity of plasmin; decreases bleeding. Taken during menses up to 5 days. More effective than NSAIDs, less effective than IUDs
BOX: n/a
CON: Thromboembolic dz, risk of thromboembolism (Hypercoag/valvular dz), pregnancy, use w/hormonal contraception
ADR: Abd/back/m/s pain. HA. Nasal sinus s/s
NSAIDs
IND: Abnormal uterine bleeding
MOA: Inhibit synthesis of prostaglandin synthesis in the endometrium; vasoconstriction. Start on first day of menses, continue thru menses
Advantages: No increased risk of thrombosis, reduces dysmenorrhea, low cost, OTC, low ADRs
