Low dose estrogen progestin pill is better than cyclical progestin as medical management of abnormal uterine bleeding due to ovulatory dysfunction in premenopausal women

Background: In abnormal uterine bleeding due to ovulation dysfunction, unopposed estrogen causes persistent proliferative or hyperplastic endometrium and periods of amenorrhea followed by excessive bleeding. This is managed medically by cyclical use of some hormonal agents. The aim of the study was to compare the effectiveness and acceptability of cyclical progestin alone and low dose estrogen progestin pill as medical management of AUB-O in premenopausal women. Methods: The study composed of 57 premenopausal women with anovular type of bleeding. The study participants were randomly allocated to take either norethisterone 10 mg daily from 16th to 25th day of menstrual cycle or low dose estrogen progesterone pill, one pill daily from 1st day of menstrual cycle up to 24th day. These patients were followed up after three and six months to assess subjectively the persistence of abnormal uterine bleeding, patient’s satisfaction, need for hysterectomy and any side effects. Results: The symptomatic improvement was more apparent with estrogen progestin pill than cyclical norethisterone. More patients chose hysterectomy in the norethisterone group because they were not satisfied with medical management. Conclusions: Symptomatic improvement is more with low dose estrogen progestin pill than cyclical norethisterone in women with AUB-O. More women decline hysterectomy as they accept estrogen progestin pill.