Menstrual Disorders - Medications

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After the LNG-IUS is inserted, heaver periods may occur during the first 3 - 6 months as the lining of the uterus is shed. This shedding may also cause irregular periods and light bleeding (“spotting”) between menstrual cycles. Eventually, the LNG-IUS results in a shorter period, with little or no blood flow. For many women, the LNG-IUS completely stops menstrual periods.

Common side effects include cramping, acne, back pain, breast tenderness, headache, mood changes, and nausea. The LNG-IUS may increase the risk for ovarian cysts, but such cysts usually cause no symptoms and resolve on their own. Women who have a history of pelvic inflammatory disease or who have had a serious pelvic infection should not use the LNG-IUS. Because of the risks associated with pelvic infection, doctors recommend that women who use the LNG-IUS be in a stable monogamous relationship. The LNG-IUS does not protect against sexually transmitted diseases.

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Injection (Depo-Provera). Depo-Provera (also called Depo or DMPA) uses the progestin medroxyprogesterone, which is administered by injection once every three months. Most women who use Depo-Provera stop menstruating altogether after a year. Depo-Provera may be beneficial for women with heavy bleeding, or pain due to endometriosis. Women who eventually want to have children should be aware that Depo-Provera can cause persistent infertility for up to 22 months after the last injection, although the average is 10 months.

Weight gain can be a problem, particularly in women who are already overweight. Women should not use Depo-Provera if they have a history of liver disease, blood clots, stroke, or cancer of the reproductive organs. Long-term (more than 2 years) use of Depo-Provera can cause loss of bone density. Because of this, Depo-Provera should not be used for longer than 2 years.

[For more information, see In-Depth Report #91: Birth control options for women.]

GnRH Agonists

Gonadotropin releasing hormone (GnRH) agonists are sometimes used to treat severe menorrhagia in women who desire future pregnancy. GnRH agonists block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicular-stimulating hormone). As a result, the ovaries stop ovulating and no longer produce estrogen.

GnRH agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron Depot), the nasal spray nafarelin (Synarel), and buserelin (Suprefact), which is given either as a nasal spray or injection. Such drugs may be used alone or in preparation for procedures used to destroy the uterine lining. They are not generally suitable for long-term use.