III. Goal: Correct Unopposed Estrogen

  1. Prevent Endometrial Hyperplasia
  2. Prevent Uncoordinated Sloughing

IV. Management

  1. Oral Contraceptive
    1. Switch to Levonorgestrel containing pill
    2. Avoid when Oral Contraceptive is contraindicated (e.g. Tobacco users over age 35 years)
    3. Limit Ethinyl Estradiol to no more than 35 mcg
      1. Lower Estrogen is not associated with bleeding
  2. Medroxyprogesterone acetate (Provera)
    1. Provera 10 mg oral daily for 10-14 days per month
  3. Norethindrone (Aygestin)
    1. Dose: 5 mg PO tid cycle days 15 to 25
  4. Micronized Progesterone (Prometrium)
    1. Dose: 200 mg PO qd for cycle days 12 to 25
  5. Levonorgetrel-Releasing IUD (Mirena)
    1. IUD containing 52 mg Levonorgestrel

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