What is the role of oral contraceptives in the treatment of abnormal uterine bleeding (AUB)?

Updated: Dec 07, 2018
  • Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Oral contraceptive pills (OCPs) suppress endometrial development, reestablish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia.

OCPs can be used effectively in a cyclic or continuous regimen to control abnormal bleeding.

Acute episodes of heavy bleeding suggest an environment of prolonged estrogenic exposure and buildup of the lining. Bleeding usually is controlled within the first 24 hours, as the overgrown endometrium becomes pseudodecidualized. Seek alternate diagnosis if flow fails to abate in 24 hours.

The type of OCP and underlying patient factors may be important determinants of potential risk for complications associated with OCPs. Studies have shown an increased risk of nonfatal venous thromboembolic events (blood clots) associated with contraceptives that contain drospirenone as compared with those that contain levonorgestrel. [10]

Levonorgestrel-releasing intrauterine system is considered a first-line treatment for adolescents with heavy menstrual bleeding. [8, 3]

A study by Jain et al indicated that in women with AUB, the NuvaRing, which releases a daily dose of 15 μg ethinyl estradiol and 120 μg etonogestrel, can control heavy menstrual bleeding as effectively as a combined oral contraceptive pill containing 30 μg ethinyl estradiol and 150 μg levonorgestrel. The study included 60 women, who used either the NuvaRing or the combined oral contraceptive pill for 3 consecutive months. Both forms of contraception significantly reduced blood loss in each menstrual cycle, with no significant difference between them on the pictorial blood loss assessment chart. [11]


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