Menstrual Disorders - Medications

Some researchers are investigating continuous oral contraceptives, either by extending a monophasic regimen or by using specific agents (e.g., Seasonale, which contains estrogen and levonorgestrel). This approach produces a period only about every three months. Continuous OCs have the potential for helping women with either heavy bleeding, painful periods, or both. Breakthrough bleeding is the most common side effect. In fact, although there are fewer actual bleeding days with the continuous OC, total days of spotting plus bleeding are no different from other OCs regimens. In one 2003 study, women were equally satisfied with both the continuous and standard OC regimens. This approach is not suitable for women who frequently miss taking their pills. Long-term effects of steady hormone use are not known, and continuous contraceptives are still in trials.

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Estrogen and progestin each cause different side effects. Uncommon but more dangerous complications of OCs include high blood pressure and deep-vein blood clots (thrombosis), which may contribute to heart attacks or strokes. It should be noted that a long-term study of 46,000 British women found no difference in mortality rates between women who took OCs and those who did not. The most serious side effects are due to the estrogen in the combined pill. Women at risk can usually take progestin-only contraceptives.

Other Forms of Combination Contraceptives. Other methods for delivering contraceptives include skin patches, monthly injections, and vaginal rings. It is not clear, however, if they have any advantages for women with heavy bleeding.

Progestins

Progestins (either natural progesterone or synthetic progestogen) are used by women with irregular or skipped periods to restore regular cycles. Because of this, they may also help menstrual pain. They also reduce heavy bleeding and appear to protect against uterine and ovarian cancers. Progestins can be delivered in various forms.

Progestin-Releasing IUDs.Intrauterine devices (IUDs) that release progestin may be very beneficial for menstrual disorders. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena, FibroPlant) is proving to have important effects on menstrual disorders, regardless of its contraceptive effects. The LNG-IUS reduces heavy bleeding and pain in many women who suffer from menorrhagia and dysmenorrhea. In one three-year study, the proportion of women with dysmenorrhea using the LNG-IUS dropped from 60% to about 30%. Some experts now recommend the LNG-IUS as a first-line treatment for menorrhagia, particularly for women who may face hysterectomy or other surgery. Studies report that about 60% of women with menorrhagia who use the LNG-IUS are able to avoid hysterectomy. Clinical trials suggest that the long-term benefits of the LNG-IUS are similar to those for endometrial resection.