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Mefenamic acid ( Ponstel) 500 mg tid daily for 3 days during the menstrual period.
Naproxen ( Anaprox, Naprosyn) 500-mg loading dose, then 250 mg three times daily for 3 days during the menstrual period.
Ibuprofen (Order cheap Motrin, Nuprin) 400-600 mg tid during the menstrual period.
These agents are equally effective. Gastrointestinal distress is common, and NSAIDs are contraindicated in renal failure and peptic ulcer disease.
Iron should also be added as ferrous gluconate 325 mg tid.
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Patients with hypovolemia or a hemoglobin level below 7 g/dL should be hospitalized for hormonal therapy, iron replacement, and possibly transfusion.
Hormonal therapy consists of estrogen (Premarin) 25 mg IV q6h until bleeding stops. Thereafter, oral contraceptive pills should be administered q6h x 7 days, then taper slowly to one pill qd.
If bleeding continues, IV vasopressin ( DDAVP) should be administered. Hysteroscopy may be necessary, and dilation and curettage is a last resort.
Iron should also be added as ferrous gluconate 325 mg tid.
Primary childbearing years–ages 16 to early 40’s
Contraceptive complications and pregnancy are the most common causes of abnormal bleeding in this age group. Anovulation accounts for 20% of cases.
Adenomyosis, endometriosis, and fibroids increase in frequency as a woman ages, as do endometrial hyperplasia and endometrial polyps. PID and endocrine dysfunction may also occur.
Laboratory tests
CBC and platelet count, Pap smear, and a pregnancy test.
Screening for sexually transmitted diseases, thyroid dysfunction, and coagulation disorders (partial thromboplastin time, INR, bleeding time) is completed.
If a non-pregnant woman has a pelvic mass, evaluation is required with ultrasonography or hysterosonography (with uterine saline infusion), and, if necessary, CT or laparoscopy.
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