by Scholten A

Medications for Menstrual Disorders

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Menstrual disorders, such as heavy bleeding or lack of menstruation, may be treated with hormonal and nonhormonal agents and therapies. These may include the following:

Prescription Medications for Heavy Bleeding (Menorrhagia)

Antihemorrhagic
Common name: tranexamic acid (eg, Lysteda)
This type of medicine may be prescribed to lessen menstrual flow and cramps.
Possible side effects include:
  • Headache
  • Sinus and nasal symptoms
  • Abdominal pain
  • Muscle and joint pain
  • Muscle cramps
  • Anemia
  • Fatigue
Oral Synthetic Progestins
Common names include:
  • Medroxyprogesterone (eg, Provera, Curretab, Cycrin, Depo-Provera)
  • Norethindrone acetate (eg, Aygestin)
  • Norgestrel/estradiol (eg, Ovral)
Oral synthetic progestins are taken during the premenstrual phase of the menstrual cycle and help prevent heavy bleeding. They are most effective when taken for 21 days of each cycle.
Possible side effects include:
  • Weight gain
  • Mood changes
  • Breast tenderness
  • Headaches
  • Acne
  • Unpredictable spotting
Natural Progestins
Common name: progesterone (eg, Prometrium)
Natural progestins may be helpful in reducing heavy bleeding with fewer side effects. They may be taken orally or as a vaginal gel.
Progestin-Containing Intrauterine Device (IUD)
Common name: levonorgestrel-releasing intrauterine system (eg, Progestasert, Mirena)
An IUD may be used for up to five years. This treatment helps to reduce heavy bleeding. It releases progestin mainly into the uterus and cervix.
Possible side effects include:
  • Irregular bleeding during the first six months
  • Nausea
  • Bloating

Over-the-Counter Medications for Heavy Bleeding (Menorrhagia)

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Common names include:
  • Ibuprofen (eg, Advil, Motrin)
  • Naproxen sodium (eg, Alleve)
Certain NSAIDs can reduce heavy bleeding by blocking prostaglandins (substances that increase uterine contractions) and reducing inflammation.
Possible side effects include:
  • Stomach pain, cramps, or discomfort
  • Heartburn
  • Indigestion
  • Nausea and vomiting

Prescription Medications for Secondary Amenorrhea

If medicines are prescribed to treat amenorrhea, they will be used to treat the underlying causes. If the cause of amenorrhea relates to lack of both estrogen and progesterone, it may be treated with hormone replacement therapy (HRT). Amenorrhea related to polycystic ovary syndrome is usually treated with birth control pills. If the underlying cause is a pituitary tumor , it may be treated with a drug that reduces the secretion of the hormone prolactin.

Prescription Medications for Amenorrhea

Combination Birth Control Pills
Common names include:
  • Desogestrel/estradiol (eg, Desogen, Mircette, Ortho-Cept)
  • Ethynodiol/estradiol (eg, Demulen, Zovia)
  • Gestodene/estradiol (eg, Minesse)
  • Levonorgestrel/estradiol (eg, Alesse, Levlen, Levlite)
  • Norethindrone acetate/estradiol (eg, Estrostep, Loestrin)
  • Norethindrone/estradiol (eg, Brevicon, Estrostep, Genora)
  • Norethindrone/mestranol (eg, Intercon, Necon, Nelova)
  • Norgestimate/estradiol (eg, Ortho-Cyclen, Ortho Tri-Cyclen)
  • Norgestrel/estradiol (eg, Lo/Ovral)
Birth control pills are often used to treat polycystic ovary syndrome (PCOS). PCOS may be an underlying cause of amenorrhea or oligomenorrhea (too few periods). The pills are intended to slow done ovarian function because the ovaries are producing too much male hormones.
Possible side effects include:
  • Abdominal pain
  • Nausea
  • Swelling
  • Weight gain
  • Mood changes
  • Breast tenderness
  • Spotting between periods
Progestogen
Progestogen is available in many forms, including oral pills, injections, intrauterine device (IUD), and vaginal gel. Examples of common names include:
  • Oral pills—medroxyprogesterone acetate (Amen, Cycrin, Provera), norethindrone (Micronor, Nor-QD), levonorgestrel (Norplant), megestrol Acetate (Megace)
  • Injection—medroxyprogesterone acetate (Depro-Provera)
  • IUD—Levonorgestrel (Mirena)
  • Vaginal gel—Progesterone (Progestasert)
If your ovaries are producing estrogen, your doctor may prescribe progestogen. In addition, if you choose estrogen replacement therapy (ERT) and have an intact uterus, progesterone must also be taken to reduce the increased risk of uterine cancer from taking ERT alone. Progesterone or progestin (synthetic progesterone) is available as replacement therapy.
Possible side effects include:
  • Fluid retention
  • Weight gain
  • Headache
  • Mood changes
Hormone Replacement Therapy (HRT)
Common brand names include:
  • Oral pills—conjugated equine estrogens and medroxyprogesterone Acetate (Premphase), conjugated equine estrogens and medroxyprogesterone acetate (Prempro), ethinyl estradiol and norethindrone acetate (Femhrt), 17-beta estradiol and norethindrone acetate (Activella)
  • Skin patch—17-beta-estradiol and norethindrone acetate (CombiPatch)
While birth control pills are the most common treatment, your doctor may recommend hormone replacement therapy (HRT)—progesterone and estrogen—if you have certain conditions, like premature ovarian failure.
Possible side effects include:
  • Uterine bleeding or “spotting”
  • Fluid retention
  • Sore breasts
  • Headache
  • Mood changes
Anti-hyperprolactinemics
Common names include:
  • Bromocriptine (Cycloset, Parlodel)
  • Carbergoline (Dostinex)
Anti-hyperprolactinemics are used to treat amenorrhea that relates to excessive secretions of the hormone prolactin, a hormone related to pituitary tumors. You should use some form of birth control while taking this medicine.
Possible side effects include:
  • Dizziness or lightheadedness, especially upon standing
  • Nausea

Special Considerations

  • Take your medicine as directed. Do not change the amount or schedule.
  • Know what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking the medicine.
  • Plan ahead for refills if you need them.
  • Do not share your medicine with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

References

Amenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated January 21, 2011. Accessed August 20, 2012.

Heavy menstrual bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated 25, 2012. Accessed August 20, 2012.

Menstruation and the menstrual cycle fact sheet. Womens Health.gov website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.cfm . Updated October 21, 2009. Accessed August 20, 2012.

11/20/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : FDA approves Lysteda to treat heavy menstrual bleeding. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190551.htm . Published November 13, 2009. Accessed November 20, 2009.

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