Comparison of Combined Oral Contraceptives and a Transdermal Estrogen Patch With Oral Progesterone - Treatment of Abnormal Uterine Bleeding in Adolescents

Oct 6, 2026

Uploaded by James

Abnormal uterine bleeding in adolescents is commonly linked to ovulatory dysfunction, and selecting an effective regimen remains challenging due to varied clinical presentations. A retrospective cohort followed 30 adolescents over six months, comparing a combined oral contraceptive (30 μg ethinyl estradiol/3 mg drospirenone) versus transdermal estrogen with oral medroxyprogesterone acetate. Early intermenstrual bleeding, pain, nausea-vomiting, and headaches differed between groups, with fewer mild side effects and better compliance and satisfaction in group A.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

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Review began 09/03/2024 Review ended 10/19/2024 Published 10/23/2024 © Copyright 2024 Ulukapi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.72218 Open Access Original Article Comparison of Combined Oral Contraceptivesand a Transdermal Estrogen Patch With Oral Progesterone: Treatment of Abnormal Uterine Bleeding in Adolescents Hasan Bora Ulukapi 1, Enver Simsek 2 1. Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TUR 2. Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, TUR Corresponding author: Hasan Bora Ulukapi, [hasan.bora.ulukapi@gmail.com](hasan.bora.ulukapi@gmail.com) Abstract Objective Abnormal uterine bleeding (AUB) is a frequent complaint in adolescents. Ovulatory dysfunction (AUB-O) is the most common etiology of AUB. We aimed to compare possible treatment modalities for idiopathic AUBO, the most common reason for AUB-O in adolescents. Methods Thirty patients who were treated with either 30 μg ethinyl estradiol/3 mg drospirenone combined oral contraceptive (group A) or 1.95 mg 17β-estradiol transdermal patch and 5 mg oral medroxyprogesterone acetate combined treatment (group B) for six months in the pediatric endocrinology department between years 2017 and 2019 were enrolled in our study retrospectively, and a questionnaire was performed on them to assess their treatment satisfaction. Results In the first three months of treatment, four (26 .6%) patients reported intermenstrual bleeding (IMB), three (20%) reported abdominal pain, two (13 .3%) reported nausea-vomiting, and one (6 . 7%) reported headaches in group A, while eight (53 .3%) patients reported IMB, six (40%) reported abdominal pain, two (13 .3%) reported nausea-vomiting, and two (13 .3%) reported headaches in group B. No major side effects were reported to cause cessation of treatment in any treatment group, but fewer mild side effects were reported in group A. Group A had better treatment compliance and satisfaction. Menstrual irregularity stopped after two months of treatment in both groups, but one (6 .6%) and three (20 .0%) patients reported that AUB repeated within three months of treatment cessation in group A and group B, respectively. Conclusion Immaturity of the hypothalamo-pituitary-ovarian axis in adolescence can present with a wide range of symptoms and proves challenging to choose the proper treatment regimen. Categories: Obstetrics/Gynecology, Endocrinology/Diabetes/Metabolism, Pediatrics Keywords: abnormal uterine bleeding, adolescent, combined oral contraceptive, ovulatory dysfunction, progestin, transdermal estrogen patch Introduction In adolescents, any deviation in hypothalamo-pituitary-gonadal axis maturation may result in abnormal uterine bleeding (AUB) [1] . While anovulatory cycles in adolescents right after menarche are common, 90% of cycles stay within normal limits. However, heavy menstrual bleeding is more frequent in adolescents (37%) compared to adults [2,3] . The classification of AUBs was redefined by the International Federation of Obstetrics and Gynecology (FIGO) in 2011 with the acronym PALM-COEIN. The letter ‘O’ in COEIN defines AUB due to ovulatory dysfunction (AUB-O) . While usually no etiology can be shown in adolescent patients with AUB-O, endocrinopathies such as polycystic ovary syndrome, hypothyroidism, hyperprolactinemia, obesity, anorexia, and late-onset congenital adrenal hyperplasia are also common etiologies [4] . Treatment of AUB-O typically involves inducing endometrial proliferation with estrogens and stabilizing the endometrium with progestins, aiming to stop heavy bleeding and prevent recurrence while discovering the etiology. With this ma

FAQs

What patient population was studied?

Thirty adolescents diagnosed with idiopathic abnormal uterine bleeding due to ovulatory dysfunction were followed for six months.

What treatments were compared in the study?

Group A received a combined oral contraceptive containing ethinyl estradiol and drospirenone, while group B received a transdermal estradiol patch plus oral medroxyprogesterone acetate.

What were the main outcome findings?

After three months, intermenstrual bleeding, abdominal pain, nausea-vomiting, and headaches were reported in both groups, with fewer mild side effects and better treatment compliance and satisfaction in group A.

Oct 6, 2026

Uploaded by James