INTRODUCTION

Surgical procedures as dictated by the diagnosis.

Perform a transvaginal ultrasound and endometrial sampling in all women over 45 years of age.

Actively exclude organic causes, e.g. fibroids, for abnormal uterine bleeding.

MEDICINE TREATMENT

Dysfunctional uterine bleeding implies that no organic cause is present.

ARREST OF ACUTE HAEMORRHAGE

For excessively heavy anovulatory dysfunctional bleeding:

Progestogen, e.g.:

• Norethisterone, oral, 5 mg 4 hourly for 24–48 hours.

OR

• Tranexamic acid, oral, 1g 6 hourly on days 1–4 of the cycle. Specialist initiated.

After bleeding has stopped, continue with:

• Combined oral contraceptive, oral, 1 tablet 8 hourly for 7 days.
  • Follow with 1 tablet once daily for 3 months.

FOR RESTORING CYCLICITY

For women in the reproductive years:

• Combined oral contraceptive, oral, 1 tablet daily for 6 months.

OR

As alternative to combined oral contraceptives:

Progesterone only:

• Medroxyprogesterone acetate, oral, 30 mg daily from day 5 to day 26 of the cycle.
  • Use for 3–6 cycles.

OR

• Norethisterone, oral, 15 mg daily from day 5 to day 26 of the cycle.
  • Use for 3–6 cycles.

For perimenopausal women, if uterus present, HRT:

• Conjugated oestrogens, oral, 0.625 mg daily for 21 days with the addition of medroxyprogesterone acetate, oral 10 mg daily from day 11 to day 21. o Day 22– 28 no treatment.
  • Use for 3–6 cycles.

ADD

For dysmenorrhoea and abnormal bleeding:

• Ibuprofen, oral, 400–800 mg 8 hourly for 2–3 days depending on severity of pain.