II. Indication
III. Goal: Correct Unopposed Estrogen
- Prevent Endometrial Hyperplasia
- Prevent Uncoordinated Sloughing
IV. Management
-
Oral Contraceptive
- Switch to Levonorgestrel containing pill
- Avoid when Oral Contraceptive is contraindicated (e.g. Tobacco users over age 35 years)
- Limit Ethinyl Estradiol to no more than 35 mcg
- Lower Estrogen is not associated with bleeding
-
Medroxyprogesterone acetate (Provera)
- Provera 10 mg oral daily for 10-14 days per month
-
Norethindrone (Aygestin)
- Dose: 5 mg PO tid cycle days 15 to 25
- Micronized Progesterone (Prometrium)
- Dose: 200 mg PO qd for cycle days 12 to 25
- Levonorgetrel-Releasing IUD (Mirena)
- IUD containing 52 mg Levonorgestrel
V. References
- Nelson (1997), Fam Prac Recert 19(8):14
- Apgar (2000) Am Fam Physician 62:1839-50 [PubMed]
- Buchanan (2009) Am Fam Physician 80(10): 1075-88 [PubMed]
- Sweet (2012) Am Fam Physician 85(1): 35-43 [PubMed]