Menstrual Disorders - Medications

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Progestins

Progestins (synthetic progesterone) 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 may protect against uterine and ovarian cancers. Progestin-only contraceptives may be a good option for women who are not candidates for estrogen-containing OCs, such as women smokers over the age of 35.

Progestins can be delivered in various forms.

Oral. Short-term treatment of anovulatory bleeding may involve a 21-day course of an oral progestin on days 5 - 26. Medroxyprogesterone (Provera) has shown benefit in treating patients with chronic pelvic pain (but not those with pain due to endometriosis, primary dysmenorrheal, or chronic active pelvic inflammatory disease).

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Intrauterine Device (Mirena). An intrauterine device (IUD) that releases progestin can be very beneficial for menstrual disorders, regardless of its contraceptive effects. In the United States, a levonorgestrel-releasing intrauterine system, also called an LNG-IUS, is sold under the brand name Mirena. The LNG-IUS has been proven to reduce heavy bleeding and pain in many women who suffer from menorrhagia and dysmenorrhea. It is the only IUD approved by the FDA to treat heavy menstrual bleeding.

Many doctors recommend the LNG-IUS as a first-line treatment for severe heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus) or conservative surgery such as endometrial ablation (destruction of the endometrial lining). This device is considered a good long-term option, particularly for women who may desire future pregnancies. Research also indicates that women who choose the LNG-IUS are as satisfied with their quality of life as those who choose surgery.

The LNG-IUS remains in place in the uterus and releases the progestin levonorgestrel for up to 5 years. Progestin released by an IUD mainly affects the uterus and cervix, and so it causes fewer widespread side effects than progestin pills do. (However, the other type of IUD -- the Copper T -- may increase bleeding.)