HIPERMENORREA: ALGORITMO DE TRATAMIENTO Y RECOMENDACIONES DEL RCOG.

TABLE 3 Therapeutic options for suppressing menses
	Extended OC regimen*	DMPA*	Levonorgestrel IUD	Norethisterone acetate†	Danocrine†	GnRH agonist
Dosage	<35 µg estrogen monophasic continuous; Seasonale (investigational drug): extended 84/7 regimen	Depo-Provera: 150 mg IM every 3 months	Mirena: Releases 20 µg levonorgestrel daily, effective for 5 years	Aygestin: 5 mg, 1–3 times daily	Danazol: 800 mg twice a day (optional titration to lowest dose sufficient to maintain amenorrhea)	Leuprolide acetate (Lupron Depot): 3.75 mg monthly or 11.25 mg every 3 months
Medical uses	Menorrhagia, dysmenorrhea, endometriosis, anemia, premenstrual syndrome, menstrual migraines	Menorrhagia, dysmenorrhea, endometriosis, anemia, premenstrual syndrome, menstrual migraines	Menorrhagia	Menorrhagia, dysmenorrhea, endometriosis, anemia, premenstrual syndrome, menstrual migraines	Endometriosis, menorrhagia	Menorrhagia dysmenorrhea endometriosis anemia premenstrual syndrome menstrual migraines
Contraception provided	Yes	Yes	Yes	Yes	No	No
Adverse effects	Breakthrough bleeding or spotting	Irregular bleeding or spotting	Intermenstrual bleeding	Progestin side effects such as bloating or mood changes	Androgenic and hypoestrogenic side effects	Hypoestrogenic side effects that can be counteracted with estrogen supplementation
Cost- effectiveness	Cost-effective if the use of sanitary products is high	Cost-effective	Initial high cost, but becomes cost-effective with extended use	More costly than extended OC regimen	Expensive	Very expensive
*None of the medical uses listed are FDA-approved indications. † Approved for the treatment of endometriosis. Approved for the treatment of endometriosis and menorrhagia-induced anemia in women with fibroids. Other GnRH agonists approved for the treatment of endometriosis include Synarel and Zoladex. DMPA—depot medroxyprogesterone acetate

Andrew Kaunitz. Cover Story: Choosing to menstruate--or not. Contemporary Ob/Gyn 2001;1:72-91.