Estrogen therapy for dysfunctional uterine bleeding

Examples

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Oral (pills or tablets):

Brand Name	Generic Name
Premarin	conjugated estrogens

Brand Name	Generic Name
Menest	esterified estrogens

Brand Name	Generic Name
Estrace	estradiol

Brand Name	Generic Name
Ogen	estropipate

Intravenous (IV):

Brand Name	Generic Name
Premarin	conjugated estrogens

Brand Name	Generic Name
Delestrogen	estradiol valerate

How It Works

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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

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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

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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

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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

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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.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Mishell DR Jr, et al. (2001). Abnormal uterine bleeding. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 1079–1097. St. Louis: Mosby.

Credits

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Author	Kathe Gallagher, MSW
Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Associate Editor	Terrina Vail
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Liisa Honey, MD, FRCSC - Obstetrics and Gynecology
Last Updated	February 12, 2008