There are several non-hormonal and hormonal agents that have proven to be effective in the treatment of abnormal uterine bleeding. Some of these may have the added benefit of providing symptom relief for dysmenorrhoea and offer contraceptive coverage. These agents may help stabilize anaemia and provide symptom relief alone, or may be utilized prior to surgical management of heavy menstrual bleeding. Medical management allows for early initiation of treatment in a primary care setting whereas surgical intervention may be limited by access to specialist consultation and operating facilities. All potential treatment options for abnormal uterine bleeding should be discussed with the patient and their side-effects, relative effectiveness, risks, costs and impact on fertility outlined so that an informed shared treatment decision can be made and a treatment plan instituted.
Sources:
Health Quality Ontario. Heavy Menstrual Bleeding: Care for Adults and Adolescents of Reproductive Age [Internet]. 2017 [cited 2017 May 29].
Laberge P, et al. SOGC clinical practice guideline: endometrial ablation in the management of abnormal uterine bleeding [Internet]. J Obstet Gynaecol Can. 2015 Apr [cited 2017 May 29];322:362-76.
Munro MG, et al. Acute uterine bleeding unrelated to pregnancy: a Southern California Permanente Medical Group practice guideline [Internet]. Perm J. 2013 [cited 2017 May 29]:17(3):43-56.
National Collaborating Centre for Women’s and Children’s Health (UK). Heavy menstrual bleeding. London: RCOG Press; 2007 Jan. PMID: 21938862.
Sukhbir S, et al. Abnormal uterine bleeding in pre-menopausal women [Internet]. J Obstet Gynaecol Can. 2013 May [cited 2017 May 29]:35(5);473-9.
Vilos GA, et al. SOCG clinical practice guideline: the management of uterine leiomyomas [Internet]. J Obstet Gynaecol Can. 2015 Feb [cited 2017 May 29]:318:157-81.