Systemic Gonadal Steroids (Bleeding Symptoms Only)

Systemic Gonadal Steroid Therapy (Progestins ± Estrogens) for AUB-L

Key Points


  • Systemic gonadal steroid therapy for leiomyomas is limited to the treatment of AUB-L
  • The agents generally comprise progestins with or without estrogen. Progestins may be administered locally (via an levonorgestrel-releasing system) or systemically with oral, implantable, or injectable formulations.
  • It is likely that when AUB-L is secondary to sub-mucous leiomyomas the response to therapy will be less robust than when the leiomyomas are not in contact with the endometrium, when they are unlikely to actually be contributing to the symptom

Combined Estrogen and Progestin Containing Contraceptives

Oral contraceptives have applications beyond family planning. They have demonstrated clinical efficacy for the treatment and prevention of menstrual bleeding disorders and menstrual-related pain symptoms. Therefore, these contraceptive drugs are important for women's health (17).

Systemic Progestins

 A systematic review published in 2016 evaluated the use of the orally administered progestin dienogest in endometrial preparation prior to myomectomy by hysteroscopy in submucosal myomas. This study showed that women who received dienogest as pre-surgical management presented a reduction in endometrial thickness and a decrease in bleeding and surgical time, concluding that its application can be effective and safe; however, more studies of higher quality are required (18).

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