Estrogen therapy for dysfunctional uterine bleeding

Examples

Oral (pills or tablets):

Generic Name	Brand Name
conjugated estrogens	Premarin
esterified estrogens	Menest
estradiol	Estrace
estropipate	Ogen

Intravenous (IV):

Generic Name	Brand Name
conjugated estrogens	Premarin
estradiol valerate	Delestrogen

How It Works

High levels of estrogen trigger the rapid growth of the uterine lining (endometrium). This stops sudden, heavy bleeding from the uterine surface.

Why It Is Used

High-dose estrogen is used to reduce sudden, heavy uterine bleeding. Usually, 24 hours of intravenous (IV) or oral (pills or tablets) estrogen therapy is followed with 7 to 10 days of oral estrogen plus progestin.¹

During perimenopause, when the body makes less estrogen, some women take estrogen along with progestin to regulate the menstrual cycle and reduce dysfunctional uterine bleeding. For more information, see birth control pills, patch, or ring.

How Well It Works

Estrogen therapy effectively controls sudden, heavy uterine bleeding that is not caused by disease, pregnancy complication, cancer, or another serious medical condition (dysfunctional uterine bleeding).¹

Recurrence Dysfunctional uterine bleeding may return when treatment with estrogen and progestin is stopped.

Side Effects

Frequent side effects caused by estrogen can include:

• Headaches.
• Nausea.
• Vaginal discharge.
• Fluid retention.
• Swollen breasts.
• Weight gain.
• Spotting or darkening of the skin, particularly on the face.

Rare side effects include:

• Increased growth of preexisting uterine fibroids.
• Worsening of endometriosis.
• Blood-clotting problems in the lungs (pulmonary embolism) or legs (deep vein thrombosis).
• Increased risk of developing gallbladder disease.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Short-term estrogen therapy is followed by 7 to 10 days of estrogen-plus-progestin treatment to stimulate healthy growth of the endometrium. When treatment stops, withdrawal bleeding, much like menstrual bleeding, can occur.

Estrogen therapy is generally not recommended if you have:

• Uncontrolled high blood pressure.
• Liver disease.
• History of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism).
• History of stroke.
• History of breast or uterine cancer.

If you have very heavy bleeding, the benefits of short-term estrogen therapy may outweigh the possible risks.

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Author:	Kathe Gallagher, MSW Debby Golonka, MPH	Last Updated: February 12, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Liisa Honey, MD, FRCSC - Obstetrics and Gynecology
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