Treatments Flashcards
Abnormal Uterine Bleeding: Irregular or light bleeding
medroxyprogesterone acetate, or norethindrone acetate, should be given for 10 days, following which withdrawal bleeding (so-called medical curettage) will occur. If successful, the treatment can be repeated for several cycles, starting medication on day 15 of subsequent cycles, or it can be reinstituted if amenorrhea or dysfunctional bleeding recurs.
Abnormal Uterine Bleeding: Heavier bleeding
Combination oral contraceptives (with 30–35 mcg of estrogen estradiol) can be given four times daily for 1 or 2 days followed by two pills daily through day 5 and then one pill daily through day 20; after withdrawal bleeding occurs, pills are taken in the usual dosage for three cycles.
Abnormal Uterine Bleeding: Intractable heavy bleeding
gonadotropin-releasing hormone (GnRH) agonist:
depot leuprolide, 3.75 mg intramuscularly monthly, or
nafarelin, 0.2–0.4 mg intranasally twice daily, can be used for up to 6 months to create a temporary cessation of menstruation by ovarian suppression.
An alternative, danazol 200 mg orally four times daily, may also create an atrophic endometrium, but is generally no longer used due to its androgenic side effects.
Abnormal Uterine Bleeding: Heavy bleeding requiring hospitalization
intravenous conjugated estrogens, 25 mg every 4 hours for three or four doses, can be used, followed by oral conjugated estrogens, 2.5 mg daily, or ethinyl estradiol, 20 mcg orally daily, for 3 weeks, with the addition of medroxyprogesterone acetate, 10 mg orally daily for the last 10 days of treatment, or a combination oral contraceptive daily for 3 weeks. This will thicken the endometrium and control the bleeding.
Abnormal Uterine Bleeding: blood loss in menorrhagia
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or mefenamic acid, in the usual anti-inflammatory doses will often reduce blood loss in menorrhagia—even that associated with a copper intrauterine device (IUD).
Abnormal Uterine Bleeding: If the abnormal bleeding is not controlled by hormonal treatment:
endometrial ablation, levonorgestrel-releasing IUD, or hysterectomy.
Post Menopausal Vaginal Bleeding: Simple endometrial hyperplasia cells
cyclic or continuous progestin therapy (medroxyprogesterone acetate, 10 mg/d orally, or norethindrone acetate, 5 mg/d orally) for 21 or 30 days of each month for 3 months. The use of a levonorgestrel intrauterine system is also a treatment option.
Post Menopausal Bleeding: Endometrial hyperplasia with atypia or if carcinoma of endometrium is found
Hysterectomy
PMS: mild to moderate symptoms
program of aerobic exercise; reduction of caffeine, salt, and alcohol intake; the use of alternative therapies, such as an increase in dietary calcium (to 1200 mg/d), vitamin D, or magnesium, and complex carbohydrates in the diet may be helpful
PMS: Multiple PMS Symptoms
Drugs that prevent ovulation, such as hormonal contraceptives, may lessen physical symptoms. A combined oral contraceptive containing the progestindrospirenone with a 4-day pill-free interval has been approved by the US Food and Drug Administration (FDA) for the treatment of PMDD. NSAIDs, such as mefenamic acid, 500 mg orally three times a day, will reduce a number of symptoms but not breast pain. When the above regimens are not effective, ovarian function can be suppressed with continuous high-dose progestin (20–30 mg/d of oral medroxyprogesterone acetate or 150 mg of depot medroxyprogesterone acetate (DMPA) orally every 3 months or GnRH agonist with add-back therapy, such as conjugated equine estrogen, 0.625 mg orally daily with medroxyprogesterone acetate, 2.5–5 mg orally daily).
PMS: mood disorders
serotonin reuptake inhibitors (such as fluoxetine, 20 mg orally, either daily or only on symptom days) have been shown to be effective in relieving tension, irritability, and dysphoria with few side effects.
