Therapies for the treatment of abnormal uterine bleeding.

Abnormal uterine bleeding (AUB) is one of the most common disorders encountered by the gynecologist. Several drugs have been demonstrated to decrease menstrual bleeding in patients with menorrhagia. Non-steroidal anti-inflammatory drugs will decrease bleeding by 30% to 50%. Oral contraceptives may be useful to stop acute bleeding and will decrease menstrual flow by approximately 50%. Tranexamic acid, a plasminogen inhibitor approved for the treatment of hemophilia, will also decrease flow by approximately 50%. Danazol and GnRH analogues both have been used for the treatment of menorrhagia. However, side effects make them unsuitable for long-term use. There are currently two medicated intrauterine devices (IUDs) available in the United States. These IUDs reduce menstrual blood loss by 65% to 85%. Several minimally invasive surgical procedures, including endometrial resection and ablation, may treat menorrhagia in select patients. More recently, various office-based ablation instruments have been developed. These machines conform to the endometrial cavity and may obviate the need for hysteroscopy.