Menstruation Disorders in Adolescents Medication
- Author: Kirsten J Sasaki, MD; Chief Editor: Andrea L Zuckerman, MD more...
Medications used in the management of menstrual disorders depend on the type of disorder and the etiology of the disorder.
Estrogen and progestin combination
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
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These agents block formation of prostacyclin, an antagonist of thromboxane, which is a substance that accelerates platelet aggregation and initiates coagulation.
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.
These agents are used to provide adequate iron for hemoglobin synthesis and to replenish body stores.
A nutritionally essential inorganic substance.
These agents inhibit secretion of pituitary gonadotropins, which subsequently cause endometrial thinning.
Etonogestrel reduces secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH), which in turn inhibits endometrial proliferation.
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.
Gonadotropin releasing hormone agonists
Suppresses ovarian and testicular steroidogenesis by decreasing LH and FSH levels.
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.
Antidiabetic agents, biguanine
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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