Clinical strategies for management of abnormal uterine bleeding: hormonal and nonhormonal interventions in women at risk for venous thromboembolism

PURPOSE OF REVIEW: This review explores the medical management of abnormal uterine bleeding (AUB) in women at risk for venous thromboembolism (VTE), with a focus on six key principles to consider when initiating hormonal therapies for this patient population. Case studies are used to illustrate these principles in practice, emphasizing the importance of assessing the patient's thrombotic risk and selecting appropriate therapies to effectively manage AUB while minimizing the risk of VTE. RECENT FINDINGS: While estrogen and certain high-dose progestins are known to elevate VTE risk, evidence suggests that progestin-only formulations and lower-dose hormonal therapies may not significantly increase this risk, even in vulnerable populations. Antifibrinolytic agents such as tranexamic acid are effective in reducing menstrual blood loss without the risk of thromboembolic complications. SUMMARY: There is wide variability in the thrombotic risks associated with the various hormonal and nonhormonal therapies available for managing AUB. A thorough evaluation of a patient's VTE risk factors and preferences is essential for effectively managing AUB in women at risk for thrombotic events.