Heavy Menstrual Bleeding Drug Summary

Drug	Dosage	Remarks
Danazol	200 mg PO 24 hourly for 12 weeks	Adverse Reactions CV effects (hypertension, edema, flushing); CNS effects (depression, dizziness, headache, sleep disorder); Dermatologic effects (acne, alopecia, mild hirsutism, rash); Endocrine effects (amenorrhea, decreased breast size, clitoris hypertrophy, increased LDL, menstrual disturbances); GI effects (nausea/vomiting, weight gain, constipation); GU effects (vaginal dryness or irritation, pelvic pain); Hematologic effects (eosinophilia, leukocytosis, leukopenia); Other effects (hepatic adenoma, paresthesia, hematuria, voice change) Special Instructions Use with caution in patients with diabetes mellitus (DM) or diseases exacerbated by fluid retention (eg asthma, epilepsy, migraine, cardiac or renal disease) Avoid in patients with undiagnosed vaginal bleeding, porphyria, severe hepatic, renal or cardiac impairment, pregnancy, breastfeeding

Drug	Dosage	Remarks
Levonorgestrel	1 IUS unit inserted into the uterine cavity within 7 days of the onset of menstruation	Adverse Reactions CNS effects (headache, depression); Endocrine effects (amenorrhea after 1 year of use, enlarged follicles, breast pain/tenderness); GI effect (abdominal pain); Dermatologic effect (acne); GU effects (uterine/vaginal bleeding/spotting, pelvic pain); Other effects (ectopic pregnancy, intrauterine device [IUD] expulsion) Special Instructions Use with caution in patients with DM, coagulopathy, congenital or other heart disease, history of ectopic pregnancy, in patients receiving anticoagulants Avoid in patients with uterine anomaly, acute pelvic inflammatory disease (PID), history of PID, uterine or cervical neoplasia, untreated cervicitis or vaginitis, unremoved IUD, undiagnosed AUB, active hepatic disease, breast cancer, pregnancy Postpartum insertion should be postponed until 6 weeks after delivery
Lynestrenol	10 mg PO 24 hourly for 10 days	Adverse Reactions CV effects (fluid retention, edema); CNS effects (depression, migraine); Dermatologic effects (urticaria, rash); Endocrine effects (gynecomastia, menstrual flow changes, breast tenderness, change in libido); GI effects (change in weight/appetite); Other effects (LFT/lipid profile changes, anaphylactic reactions) Special Instructions Use with caution in patients with DM, hypertension, migraine, depression, diseases exacerbated by fluid retention (eg asthma, epilepsy, migraine, cardiac or renal disease) Avoid use in patients with history or active thromboembolic disorders, hepatic disease, breast cancer, undiagnosed vaginal bleeding, pregnancy
Medroxyprogesterone	2.5-10 mg PO 24 hourly for 5-10 days starting on the sixteenth day of menstrual cycle	Adverse Reactions CNS effects (depression, dizziness, headache); Endocrine effects (irregular menses, decreased libido); GI effects (abdominal pain, weight gain); CV effect (edema); Dermatologic effects (acne, rash); Other effects (dysmenorrhea, vaginitis, arthralgia, bone mineral loss, anaphylactic reactions, ectopic pregnancy) Special Instructions Use with caution in patients with DM, depression, diseases exacerbated by fluid retention (eg asthma, epilepsy, migraine, cardiac or renal disease) Avoid use in patients with history or active thromboembolic disorders, cerebrovascular disease, hepatic disease, breast cancer, undiagnosed vaginal bleeding, pregnancy
Nomegestrol acetate	5 mg PO 24 hourly from sixteenth to twenty-fifth day of cycle	Adverse Reactions Endocrine effects (modification of menstruation, amenorrhea, intercurrent bleeding); Other effects (weight gain, insomnia) Special Instructions Use with caution in patients with history of MI, cerebrovascular diseases, hypertension, DM, predisposition to thromboembolism Avoid in patients with thrombophlebitis, liver dysfunction, undiagnosed genital hemorrhage
Norethisterone (Norethindrone)	10-15 mg/day PO divided 8 hourly for 10 days, in a cyclical regimen	Adverse Reactions CV effects (cerebral embolism, DVT, edema); CNS effects (depression, dizziness, migraine, mood swings); Dermatologic effects (acne, chloasma, rash); Endocrine effects (amenorrhea, menstrual flow changes, breast tenderness); GI effects (nausea, weight gain/loss); Other effects (LFT abnormalities, pulmonary embolism, anaphylactic reactions) Special Instructions Use with caution in patients with DM, hyperlipidemias, high risk of thromboembolism, depression, diseases exacerbated by fluid retention (eg asthma, epilepsy, migraine, cardiac or renal disease) Avoid use in patients with history or active thromboembolic disorders, hepatic disease, breast cancer, undiagnosed vaginal bleeding, pregnancy

Drug	Dosage	Remarks
Dienogest/estradiol valerate	1 tab PO 24 hourly starting on day 1 of menses for 28 days	Adverse Reactions CV effects (edema, varicose vein aggravation); CNS effects (depression, migraine, mood swings); Dermatologic effects (chloasma, rash); Endocrine effects (amenorrhea, menstrual flow changes, breast tenderness, spotting); GI effects (bloating, abdominal cramps, nausea/vomiting, weight change); GU effects (endocervical hyperplasia, fibroid enlargement, vaginal candidiasis); Hematologic effects (decreased folate, porphyria exacerbation); Other effects (contact lens intolerance, rhinitis, anaphylactic reactions, systemic lupus erythematosus [SLE] exacerbation) Associated with arterial thromboembolism, cerebral hemorrhage, cerebral thrombosis, hypertension, MI, venous thrombosis, gallbladder disease, hepatic adenomas, retinal thrombosis, pulmonary embolism Special Instructions Use with caution in patients with DM, familial defects of lipoprotein metabolism, high risk of thromboembolism, depression, diseases exacerbated by fluid retention (eg asthma, epilepsy, migraine, cardiac or renal disease) Avoid use in patients with history or active thromboembolic disorders, cerebrovascular disease, coronary artery disease, valvular heart disease, uncontrolled hypertension, thrombophilias, DM with vascular involvement, severe headache with focal neurological symptoms, migraine, hepatic disease, breast or endometrial cancer, smoking ≥15 cigarettes/day, pregnancy
Levonorgestrel/ethinyl estradiol1	1 tab PO 24 hourly starting on day 1 of menses for 21 days
1Combination with Ferrous fumarate is available. Please see the latest MIMS for specific formulations and prescribing information.

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.