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Medication Causes of Abnormal Uterine Bleeding

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Medication Causes of Abnormal Uterine Bleeding, Abnormal Uterine Bleeding due to Medication, Abnormal Uterine Bleeding Associated with Hormonal Contraception

  • See Also
  1. Abnormal Uterine Bleeding Causes
  2. Abnormal Uterine Bleeding
  3. Oral Contraceptive-Related Uterine Bleeding Management
  • Approach
  1. See Abnormal Uterine Bleeding
  2. General
    1. Pregnancy Test (bHCG) in all patients
    2. Sexually Transmitted Infection (STI) screening as indicated
    3. Cervical Cancer Screening (e.g. Pap Smear) if not up to date
  3. Hormonal Contraception related uterine bleeding
    1. Evaluate for Contraception compliance and missed doses (consider reminder apps and other tools)
    2. Evaluate for other hormonal agents
    3. Evaluate for Drug Interactions that alter Estrogen metabolism
  1. Levonorgestrel IUD (e.g. Mirena, Liletta, Kyleena, Skyla)
    1. Associated with prolonged bleeding in first 3 months
    2. Bleeding decreases in the first 12 months in 90% of patients
    3. Up to 20% will have Amenorrhea within 12 months
  2. Progesterone Implant (e.g. Nexplanon, Implanon)
    1. Frequent or prolonged bleeding occurs in 23% of patients (unlike IUD, often persists)
  3. Depo Provera (DMPA)
    1. Associated with prolonged Menses in 26% in first 3 months of use, but improves with continued use
    2. Abnormal Uterine Bleeding resolves in 85% of patients within first 12 months
  4. Oral Contraceptives
    1. See Oral Contraceptive-Related Uterine Bleeding Management
    2. Most common cause of mid-cycle bleeding
    3. Abnormal Uterine Bleeding occurs in up to 50% of patients in first 3-6 months (10% afterward)
  1. Anticoagulants and antiplatelet agents
    1. High dose Aspirin (e.g. 325 mg)
    2. Warfarin
  2. Endocrine agents
    1. See Hormonal Contraception as above
    2. Corticosteroids
    3. Estrogen Replacement Therapy or Herbal Estrogen
    4. Tamoxifen
  3. Herbal supplements
    1. Ginseng
    2. Ginkgo
    3. Soy Protein
  4. Neuropsychiatric agents
    1. Lithium
    2. Tricyclic Antidepressant
    3. Selective Serotonin Reuptake Inhibitors (SSRI)
    4. Sedative-Hypnotic Medications
    5. Antipsychotic Medications
    6. Phenytoin
  5. Miscellaneous
    1. Rifampin
    2. Tobacco Abuse
  • References
  1. Shwayder (2000) Obstet Gynecol Clin North Am 27:219-34 [PubMed]
  2. Schrager (2024) Am Fam Physician 109(2): 161-6 [PubMed]