Table S1. Example treatment options for abnormal uterine bleeding (AUB)

Treatment / Benefits/Pros / Risks/Cons / Impact on Fertility
Oral contraceptives / Success rate for control of AUB is 50-65%a
Inexpensive (~$5/month)
May discontinue and choose another method at any time
No recovery time / OCPs contraindicated among smokers over age 35c
Requires patient adherence to daily regimen
Patient may experience mild weight gain
If treatment is discontinued, AUB likely to recur / Reversible following discontinuation
~99% effective contraception for adherent patients
Depo Lupron (GnRH agonist) / Success rate is more than 90%e
May discontinue and choose another method at any time
No recovery time / May experience hot flashes, night sweats, bone loss due to loss of estrogen
May experience sexual dysfunction (eg vaginal dryness, loss of libido)
May not be appropriate for long-term treatment; may require add-back regimens / No contraceptive benefit
Must continue to use effective birth control methods due to risk of birth defects
Cyclic or continuous progestins / Success rate is 30-50% e
May discontinue and choose another method at any time
May be used by smokers; few contraindications to progestin use
No recovery time / Associated with premenstrual-like side effects (eg bloating, headache, weight gain and breast tenderness)
May not be appropriate for long-term treatmente,f
Requires patient adherence to treatment 12-14 days/month / No contraceptive benefit
Non-Steroidal Anti-Inflammatory Medications (NSAIDs) / Success rate for reduced bleeding is 33-55% f
May discontinue and choose another method at any time
Only required to take during menses, adherence easier
No recovery time / 10-50% of women may experience gastrointestinal side effects (eg nausea, diarrhea, abdominal discomfort) / No impact on fertility
No contraceptive benefit
Intrauterine device / Success rate for control of AUB is >75-95%b
May discontinue and choose another method in future
No recovery time / Not always covered by insurance
Requires medical visit to implant or remove device
May increase risk of infection if exposed to STDs
Placement sometimes painful / Reversible following removal
77-99% effective contraception
Uterine Ablation / Outpatient procedure
Return to normal routine in 1-2 days
Success rate for control of AUB is 85%d / Requires surgical copay
Requires anesthesia
Small (3%) risk of endometrial perforation dor infection d
10-15% will still have to have additional surgeryd
Must avoid intercourse for ~2 weeks following procedure
May experience sexual dysfunction (eg vaginal dryness) / Not for patients who wish to retain fertility
Pregnancy unlikely after ablation, but if so, serious complications may occur
Must continue to use effective birth control methods
Hysterectomy/ Supracervical hysterectomy / Success rate for control of AUB is nearly 100%d / Requires hospital stay and surgical copay
Risks of surgery include infection, bleeding, damage to other organs, blood clots
Requires anesthesia
Recovery time at least 6 weeks
Must avoid intercourse for up to 6 weeks or longer, if bleeding persists
May experience sexual dysfunction (eg vaginal dryness, change in libido) / Termination of fertility

aIyer V, Farquar C, Jepson RG. Oral contraceptive pills for heavy menstrual bleeding.CochraneDatabase of Systematic Reviews 1997; 2:CD000154. DOI: 10.1002/14651858.CD000154;Davis A, Goodwin A, Lippman J, Olson W, Kafrissen M. Triphasicnorgestimate-ethinyl estradiol for treating dysfunctional uterine bleeding. ObstetGynecol2000; 96(6):913-920.

bCasablanca Y. Management of dysfunctional uterine bleeding. ObstetGynecolClin N Am 2008; 25:219-234.

cAlbers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Physician 2004; 69(8):1915-26

dDickersin K, Munro M, Langenberg P, et al. Hysterectomy compared with endometrial ablation

for dysfunctional uterine bleeding: a randomized controlled trial. ObstetGynecol2007; 110:1279–89

eRoy SN and Bhattacharya S. Benefits and risks of pharmacologic agents used in the treatment of menorrhagia. Drug Safety2004; 27(2):75-90.

fNelson AL and Teal SB. Medical therapies for chronic menorrhagia.ObstGyn Survey 2007; 62(4):272-281.