Oral hormonal therapy as treatment option for abnormal uterine bleeding

Abstract

Background

abnormal 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 methods

a search in PubMed/MEDLINE database was conducted in order to find relevant and recent meaningful sources for this narrative review.

Results

LNG-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.

Conclusions

In 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.

SHORT CONDENSATION

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.

摘要

背景:异常子宫出血(AUB)是患者转诊到妇科医生的常见原因, 并严重影响生活质量。一旦排除了需要手术治疗的器质性原因, 临床医生应以最有效的方式保守地对这些患者进行管理。

材料和方法: 在 PubMed/MEDLINE 数据库中进行搜索, 以便为本叙事性综述找到相关的、最新的、有意义的资料。

结果: LNG-IUS 52mg是治疗非器质性病因的一线药物。尽管如此, 患者也有可能具有禁忌症或拒绝应用。复方口服避孕药(COC)和仅含孕激素制剂会抑制下丘脑-垂体-卵巢轴能抑制排卵, 诱发内膜萎缩。因此, 这些药物能有效治疗 AUB。此外, 含有雌激素、孕激素和 GnRH 拮抗剂复方制剂的新药也已上市, 用于治疗与子宫肌瘤有关的 AUB。

结论:在日常临床实践中, 当患者具有禁忌症或拒绝应用LNG-IUS 52 mg时, 口服激素疗法是治疗AUB的方便且可逆的手段。许多口服激素疗法被用于治疗AUB, 但只有少数被批准用于这一特定适应症, 有必要进一步开展设计良好的大型研究, 以比较不同药物对 AUB 的疗效。

简短总结

尽管LNG-IUS 52 mg是治疗异常子宫出血的一线药物, 但在出现禁忌症或患者拒绝用药时, 口服激素治疗应由妇科医生进行有效管理。避孕药是实用的, 有必要进行进一步的研究, 以比较其疗效, 并批准其作为特定AUB的适应症。

Keywords:

• Abnormal uterine bleeding
• oestrogens
• progestins
• contraceptive pill

Ethical approval

The authors report that ethics approval was not required for this narrative review.

Disclosure statement

No potential conflict of interest was reported by the author(s).