Treatment of Abnormal Uterine Bleeding with Estrogen Therapy

Patient Evaluation and Management

Rule out pregnancy with β-hCG testing before initiating any estrogen therapy, as part of the pre-treatment workup for women with abnormal uterine bleeding 1
Assess hemodynamic stability first—patients with hypovolemia require urgent evaluation and may need curettage, and imaging with combined transabdominal and transvaginal ultrasound with Doppler is necessary to identify structural causes 1
Laboratory testing, including pregnancy test, thyroid-stimulating hormone, and prolactin levels, is required before initiating estrogen therapy 1

Avoid estrogen therapy entirely in women with spontaneous coronary artery dissection (SCAD) or established cardiovascular disease, as hormonal therapy is relatively contraindicated 2
Avoid NSAIDs and tranexamic acid in cardiovascular disease patients due to MI and thrombosis risk 2, 1

Women on antiplatelet or anticoagulant therapy experience exacerbated abnormal uterine bleeding in 9-14% of cases, and reassess indication for ongoing antiplatelet therapy before treating bleeding 3, 1
Levonorgestrel-releasing intrauterine device (20 μg/day) reduces menstrual blood loss by 71-95% and is the most effective medical approach for long-term management of abnormal uterine bleeding 2