Menstrual disturbances in perimenopausal women: What's best?
Abstract
It's best to start with nonsteroidal anti- inflammatory drugs (NSAIDs), which effectively reduce heavy menstrual bleeding
(strength of recommendation [SOR]: B,
systematic review of randomized clinical
trials [RCTs]). Perimenopausal women with heavy bleeding not controlled by NSAIDs, or other forms of dysfunctional uterine bleeding, can benefit from continuous, combined hormonal therapy with estrogen and
progestin; hormonal therapy with estrogen
and a cyclical progestin; or a cyclical
progestin alone (SOR: B, RCTs and a
systematic review of RCTs). Intrauterine
devices (IUDs) containing levonorgestrel
also effectively reduce bleeding and
may avoid surgical intervention (SOR: B,
systematic review of RCTs).
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