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Menstruation Disorders in Adolescents Medication

  • Author: Kirsten J Sasaki, MD; Chief Editor: Andrea L Zuckerman, MD  more...
 
Updated: Mar 09, 2015
 

Medication Summary

Medications used in the management of menstrual disorders depend on the type of disorder and the etiology of the disorder.

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Estrogen and progestin combination

Class Summary

In patients with secondary amenorrhea who have a completely normal physical examination, medroxyprogesterone can be used to diagnose anovulation as the cause of amenorrhea (progesterone challenge test). Estrogens are effective in controlling acute, profuse bleeding. Estrogen also induces formation of progesterone receptors, making subsequent treatment with progestins more effective.

Ethinyl estradiol and a progestin derivative (Ovral, Ortho-Novum, Ovcon, Genora)

 

Combination pills of estrogen and progesterone in varying doses are used in the management of DUB. 21-day or 28-day cycles are used. Reduces secretion of LH and FSH from pituitary by decreasing amount of GnRH

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

These agents block formation of prostacyclin, an antagonist of thromboxane, which is a substance that accelerates platelet aggregation and initiates coagulation.

Naproxen (Aleve, Anaprox, Naprosyn)

 

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.

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Mineral Supplements

Class Summary

These agents are used to provide adequate iron for hemoglobin synthesis and to replenish body stores.

Iron sulfate (Feosol, Feratab, Fer-Iron, Slow-FE)

 

A nutritionally essential inorganic substance.

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Progestins

Class Summary

These agents inhibit secretion of pituitary gonadotropins, which subsequently cause endometrial thinning.

Etonogestrel implant (Nexplanon)

 

Etonogestrel reduces secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which in turn inhibits endometrial proliferation.

Levonorgestrel (Mirena)

 

Levonorgestrel reduces secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which in turn alters the endometrium.

Medroxyprogesterone acetate (Depo-Provera)

 

Progestin therapy in adolescents produces regular cyclic withdrawal bleeding until maturity of positive feedback system is achieved. Progestins stop endometrial cell proliferation, allowing organized sloughing of cells after withdrawal. Typically does not stop acute bleeding episode but produces a normal bleeding episode following withdrawal.

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Gonadotropin releasing hormone agonists

Class Summary

Suppresses ovarian and testicular steroidogenesis by decreasing LH and FSH levels.

Leuprolide acetate (Eligard, Lepron Depot)

 

Works by reducing concentration of GnRH receptors in the pituitary via receptor down regulation and induction of postreceptor effects, which suppress gonadotropin release. After an initial gonadotropin release associated with rising estradiol levels, gonadotropin levels fall to castrate levels, with resultant hypogonadism. This form of medical castration is very effective in inducing amenorrhea, thus breaking ongoing cycle of abnormal bleeding in many anovulatory patients. Because prolonged therapy with this form of medical castration is associated with osteoporosis and other postmenopausal side effects, many practitioners add a form of low-dose hormonal replacement to the regimen. Because of the expense of these drugs, they usually are not used as a first line approach but can be used to achieve short-term relief from a bleeding problem, particularly in patients with renal failure or blood dyscrasia.

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Antidiabetic agents, biguanine

Metformin (Fostamet, Glucophage, Glumetza, Riomet)

 

Metformin has been demonstrated to decrease ovarian androgen production and insulin levels, and it may improve ovulation rates; however, it is not currently approved for treatment of PCOS-related menstrual dysfunction. Metformin in many, but not all, studies successfully treated hirsutism in patients with PCOS secondary to insulin resistance. Not effective if patient does not have insulin resistance.

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Contributor Information and Disclosures
Author

Kirsten J Sasaki, MD Associate, Advanced Gynecologic Surgery Institute

Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Miller, MD, FACOG Clinical Associate Professor, Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine; Director, Minimally Invasive Gynecologic Surgery, Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital

Charles E Miller, MD, FACOG is a member of the following medical societies: Endometriosis Association, International Academy of Pelvic Surgery, International Society for Gynecologic Endoscopy, Society of Reproductive Surgeons, Society of Robotic Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AbbVie, Covidien, Ethicon, Gynesonics, Halt Medical, Hologic, Inc., Intuitive Surgical, Pacira Pharmaceuticals, Smith & Nephew Endoscopy, Stryker Endoscopy<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ethicon, Intuitive Surgical, Smith & Nephew Endoscopy<br/>Royalties for: Thomas Medical/Catheter Research, Inc. (Miller Catheter).

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Latha Chandran, MBBS, MD, MPH Professor of Pediatrics, Vice Dean for Undergraduate Medical Education, Stony Brook University School of Medicine, New York

Latha Chandran, MBBS, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

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