Table 5

Evidence-based assessment of hormonal therapy in patients with inherited bleeding disorders68

Hormonal productEfficacyOther clinical factors
Levonorgestrel-releasing intrauterine systemMost effective therapy for heavy menstrual bleeding

  • Provides 5 yr of therapy

  • Contraception failure rate < 0.1%

  • Removal requested by patient in 17%–20% of cases

  • Spontaneous expulsion rate 8% (decreased with associated use of tranexamic acid)

Combined hormonal contraception (birth control pill, transdermal patch and vaginal ring)Effective for contraception and menses suppression

  • Can be used monthly or continuously for 12 mo

  • Break-through bleeding can occur

Progesterone only (pill, intramuscular medroxyprogesterone or intradermal implant)Reduces menstrual blood loss with irregular bleeding—