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decision pointShould I treat dysfunctional uterine bleeding with hormone therapy?

See your health professional about irregular vaginal bleeding to make sure that a serious medical condition is not causing the bleeding. If a serious cause is ruled out, your condition is considered dysfunctional uterine bleeding. You may wait and see if your bleeding becomes more regular, or your doctor may recommend hormone therapy or a surgical procedure.

Consider the following when making your decision about using hormone therapy for dysfunctional uterine bleeding:

  • You may choose to wait and see if your bleeding gets better (watchful waiting) without treatment if you are younger than 20 or approaching menopause. If you are a teen, your cycles are likely to even out as your body matures. Women approaching menopause will have a natural end to menstrual bleeding over time.
  • Treatment can help regulate menstrual bleeding. You may have to try more than one type of treatment before you find one that works for you.
  • Hormones, such as a progestin pill (taken 10 to 12 days every month) or daily birth control pill (progestin and estrogen) may help regulate the menstrual cycle and reduce bleeding and cramping.
  • Smoking while taking the estrogen-progestin birth control pill increases the risk for blood clots (thromboembolism) and high blood pressure. Progestin therapy and the levonorgestrel IUD do not carry these two risks. Estrogen-progestin birth control pills are not usually prescribed if you smoke and are older than 35.
  • If you have no pregnancy plans, you can consider a surgical procedure instead, such as endometrial ablation or hysterectomy.

What is dysfunctional uterine bleeding?

Dysfunctional uterine bleeding is irregular menstrual bleeding that isn't caused by a serious condition such as disease or a pregnancy complication. It is usually caused by changing hormone levels, which may affect ovulation. Dysfunctional uterine bleeding is most common during the teen and perimenopausal years, when reproductive hormones tend to fluctuate.

You may have dysfunctional uterine bleeding if you have one or more of the following symptoms:

  • Menstrual bleeding that occurs more often than every 21 days (a normal menstrual cycle is 21 to 35 days long).
  • Menstrual bleeding that lasts longer than 7 days (normally 4 to 6 days).
  • Blood loss of more than 80mL each menstrual cycle (normally about 30mL). If you are passing blood clots or soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered heavy.

These symptoms can also be signs of a serious medical problem. If you have the above symptoms, your health professional must check for all serious causes of abnormal vaginal bleeding, such as miscarriage or disease, before concluding that you have dysfunctional uterine bleeding.

What are the risks of dysfunctional uterine bleeding?

Heavy uterine bleeding can lead to anemia, causing weakness, pale skin, and general tiredness (fatigue). In cases of severe uterine bleeding, blood transfusion is used to quickly restore needed blood volume.

Over time, irregular uterine bleeding can make it difficult to have an active life. Irregular bleeding can interfere with daily living and sports activities, as well as sexual relations.

How is dysfunctional uterine bleeding treated?

A number of treatment options are available for irregular uterine bleeding that has no serious cause (dysfunctional uterine bleeding). Each of these options works well for some women, but not others. Treatments include:

  • Watchful waiting for a teenager or for a woman approaching menopause. Menstrual cycles usually even out as a teen's body matures, and a woman's cycles end at menopause.
  • Hormone treatment.
    • The levonorgestrel IUD releases a form of the hormone progesterone into the uterus. This reduces bleeding while preventing pregnancy.
    • If you've been bleeding because of low progesterone, progestin treatment can help you start bleeding normally.
    • Birth control (progestin and estrogen) pills can help regulate your cycle, prevent ovulation, and reduce or stop menstrual bleeding.
  • Seldom-used medicines that stop estrogen production and menstruation, such as gonadotropin-releasing hormone analogues (GnRH-As). This drug isn't commonly used for long-term treatment because of severe side effects.
  • Surgery, such as dilation and curettage (D&C) for short-term relief of severe bleeding or endometrial ablation for longer-term relief of bleeding. In uncontrollable cases of uterine bleeding, the uterus can be removed (hysterectomy).

If you need more information, see the topic Dysfunctional Uterine Bleeding.

Your treatment choices are:

  • Use hormone therapy (progestin, levonorgestrel IUD, or birth control pills).
  • Do not use hormone therapy. Another treatment option may be more appropriate for you.

The decision about whether to treat irregular menstrual (dysfunctional uterine) bleeding with hormone therapy takes into account your personal feelings and the medical facts.

Deciding about hormone therapy for dysfunctional uterine bleeding
Reasons to use hormone therapy for dysfunctional uterine bleeding Reasons not to use hormone therapy for dysfunctional uterine bleeding
  • You are not ovulating and have irregular bleeding. (Taking progestin can return your progesterone levels to normal. This should help regulate your monthly menstrual bleeding.)
  • You need dependable birth control. (The levonorgestrel IUD or birth control pills are highly effective birth control measures and should help regulate uterine bleeding. Progestin alone will not necessarily prevent pregnancy.)
  • You are perimenopausal and have irregular bleeding. (Birth control pills should stabilize your menstrual cycle and may reduce other perimenopausal symptoms related to low estrogen.)
  • You want to have the option of getting pregnant at a later time.

Are there other reasons you might want to use hormone therapy for dysfunctional uterine bleeding?

 

 

 

 

  • You have tried one or more types of hormone therapy, and it has not effectively reduced bleeding or has caused troublesome side effects.
  • You are a smoker. Smoking while taking the estrogen-progestin birth control pill increases blood clot (thromboembolism) and high blood pressure risks, especially if you are older than 35. (Progestin therapy and the levonorgestrel IUD do not carry these risks.)
  • Your bleeding is not severe enough to cause problems with anemia. (You may choose watchful waiting.)
  • You think you are nearing menopause and prefer to let your body naturally end menstruation. (You may prefer watchful waiting.)
  • You are not comfortable with the idea of taking hormones or using a levonorgestrel IUD. (You may prefer watchful waiting or a surgical procedure.)
  • You have no pregnancy plans and have decided on surgery to treat your symptoms.

Are there other reasons you might not want to use hormone therapy for dysfunctional uterine bleeding?

 

 

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about whether you want to use hormone therapy to treat dysfunctional uterine bleeding. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have irregular bleeding. Yes No Unsure
I need to do something to reduce the amount of bleeding I'm having. Yes No Unsure
I am a teenager, and I know that my menstrual cycle may naturally become more regular as my hormone levels even out. Yes No NA*
I am perimenopausal, or I am age 35 or over and may be early perimenopausal. I realize that irregular bleeding may go away on its own when menopause is complete. Yes No NA
I have plans for pregnancy sometime in the future. Yes No Unsure
I would like a treatment that also provides birth control and preserves my future fertility. Yes No Unsure
I am open to the idea of taking hormone therapy for my symptoms. Yes No Unsure
I realize that I might have to try more than one type of hormone treatment in an attempt to find one that works best for me. Yes No NA
I might prefer surgery instead of first trying hormone therapy. Yes No Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use hormone therapy for dysfunctional uterine bleeding.

Check the box below that represents your overall impression about your decision.

Leaning toward using hormone therapy

 

Leaning toward NOT using hormone therapy

         
Author Kathe Gallagher, MSW
Associate Editor Lila Havens
Primary Medical Reviewer Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated February 9, 2010

WebMD Medical Reference from Healthwise

Last Updated: February 09, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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