Oral hormonal therapy as treatment option for abnormal uterine bleeding

Backgroundabnormal uterine bleeding is a very frequent reason for referral to gynaecologists and can deeply influence the quality of life. Once organic causes requiring surgical treatment are ruled out, clinicians should be able to manage these patients conservatively in the most effective way.Materials and methodsa search in PubMed/MEDLINE database was conducted in order to find relevant and recent meaningful sources for this narrative review.ResultsLNG-IUS 52 mg is the first-line treatment for non-organic causes. Nevertheless, it could be contraindicated or declined by the patient. Combined oral contraceptives (COC) and progestin-only pills inhibit the hypothalamic-pituitary-ovarian axis, preventing ovulation, and induce endometrial atrophy. Consequently, they are effective in treating AUB. Moreover, brand new pills containing a combination of oestrogens, progestins and GnRH antagonists are now available for the management of AUB related to uterine fibroids.ConclusionsIn daily clinical practice, oral hormonal therapies are convenient and reversible tools to manage AUB when LNG-IUS 52 mg is contraindicated or turn down by the patient. Many oral hormonal therapies are prescribed to treat AUB, but only a few have been approved with this specific indication, therefore further large well-designed studies are necessary in order to compare the efficacy of different pills for treating AUB. Even though LNG-IUS 52 mg is the first-line treatment for abnormal uterine bleeding, oral hormonal therapies should be effectively managed by gynaecologists in case of contraindications or patient's decline. Contraceptive pills are practical, but further studies are necessary to compare their efficacy and to approve them with the specific AUB indication.

Automated summary

LNG-IUS 52 mg is the first-line treatment for non-organic causes of abnormal uterine bleeding, but oral hormonal therapies are practical alternatives when LNG-IUS 52 mg is contraindicated or declined by the patient. Further studies are necessary to compare the efficacy of different oral hormonal therapies for treating abnormal uterine bleeding and to approve them with this specific indication.