What Is the Drug of Choice for DUB? An Overview of Treatment Options

October 12, 2025 •

3 min read

An estimated 1 in 20 women aged 30–49 consult a doctor each year for heavy menstrual bleeding, a condition that includes what was historically called dysfunctional uterine bleeding (DUB). While there is no single drug of choice for DUB that fits every person, effective medical management is highly personalized based on a woman's reproductive goals and medical history.

Quick Summary

There is no universal "drug of choice" for dysfunctional uterine bleeding (DUB), now classified as abnormal uterine bleeding (AUB) related to ovulatory dysfunction. Treatment options are customized based on the patient's circumstances and reproductive desires, encompassing highly effective hormonal options like the levonorgestrel-releasing IUS and combined oral contraceptives, as well as non-hormonal alternatives like tranexamic acid and NSAIDs.

Key Points

Personalized Approach: There is no single drug of choice for DUB; the best option depends on individual factors.
LNG-IUS is Highly Effective: The levonorgestrel-releasing intrauterine system is a first-line option and highly effective for long-term heavy menstrual bleeding reduction and contraception.
Combined Oral Contraceptives Offer Regulation: COCs are a common and effective choice for regulating cycles, particularly in adolescents and those also seeking contraception.
Non-Hormonal Options Preserve Fertility: Tranexamic acid and NSAIDs are effective medical alternatives for those not seeking contraception.
Acute Bleeding Requires Immediate Control: Severe, acute DUB may be managed with high-dose hormonal therapy.
Surgical Options are Later-Stage: Endometrial ablation or hysterectomy are considered when medical treatments fail.

The Shift from DUB to AUB-O Terminology

For decades, "dysfunctional uterine bleeding" (DUB) referred to abnormal uterine bleeding (AUB) without a structural cause. The current PALM-COEIN classification system uses AUB-O for abnormal uterine bleeding due to ovulatory dysfunction, which aligns with the historical definition of DUB.

Individualizing the Drug of Choice

Determining the most suitable "drug of choice" for DUB requires a personalized approach. Factors include the patient's age, desire for future fertility, need for contraception, bleeding severity and timing, and existing health conditions.

First-Line Medical Treatments for Chronic AUB

Long-term management of heavy menstrual bleeding without underlying structural issues typically begins with medical therapies.

The Levonorgestrel-Releasing Intrauterine System (LNG-IUS)

The LNG-IUS (e.g., Mirena) is a highly effective long-term treatment for heavy menstrual bleeding, significantly reducing blood loss. It works by releasing levonorgestrel directly into the uterus, thinning the lining and reducing menstrual flow. Advantages include long-term effectiveness, reliable contraception, and preservation of fertility. Potential drawbacks include initial irregular bleeding and possible progestogenic side effects.

Combined Oral Contraceptives (COCs)

COCs, containing estrogen and progestin, are a common choice, particularly for those needing contraception or regulating anovulatory cycles. COCs stabilize the uterine lining and establish predictable bleeding patterns, reducing blood flow. Benefits include cycle regulation, reduced menstrual flow and cramps, and effective contraception. Risks include an increased chance of blood clots, making them unsuitable for some individuals, and potential side effects like nausea.

Non-Hormonal Options

For individuals who prefer to avoid hormones or are planning pregnancy, non-hormonal treatments are available.

Tranexamic Acid (TXA): This antifibrinolytic medication aids blood clotting and is used during heavy bleeding days. It does not provide contraception and preserves fertility but requires caution in those with a history of blood clots.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications like ibuprofen can reduce blood loss and menstrual cramps by inhibiting prostaglandins. NSAIDs are generally less effective for reducing bleeding compared to TXA or the LNG-IUS.

Medical Treatment Comparison Table

Detailed information regarding treatment options including LNG-IUS, Combined Oral Contraceptives, Tranexamic Acid, NSAIDs, and Oral Progestins, their effectiveness, advantages, disadvantages, and target patient can be found at {Link: Dr.Oracle https://www.droracle.ai/articles/123128/what-oral-contraceptives-to-use-in-dub-in-adolescent}.

Managing Acute, Severe DUB

Severe, sudden bleeding requires immediate management. This can involve high-dose combined oral contraceptives or oral progestins. Intravenous conjugated estrogen is an option for hospitalized, stable patients. Non-hormonal treatments like tranexamic acid can also be used in acute situations.

The Role of Surgical Intervention

Surgery is typically considered when medical treatments are ineffective, not suitable, or for those seeking a permanent solution. Endometrial ablation, which destroys the uterine lining, is an option but not recommended for those wanting future pregnancies. Hysterectomy, the removal of the uterus, is a definitive treatment reserved for severe cases where other options have failed and fertility is not desired.

Conclusion

There is no single drug of choice for DUB; instead, treatment is tailored to the individual's needs and preferences. Options range from highly effective hormonal therapies like the LNG-IUS and COCs to non-hormonal choices such as tranexamic acid and NSAIDs. Consulting a healthcare provider is crucial to identify the cause of heavy or irregular bleeding and establish a personalized management plan. For more detailed information, resources like the ACOG guidelines on abnormal uterine bleeding are available.

Frequently Asked Questions

Dysfunctional Uterine Bleeding (DUB) is an older term for abnormal uterine bleeding without a structural cause. The current PALM-COEIN classification system uses AUB-O for abnormal uterine bleeding due to ovulatory dysfunction, which aligns with the historical definition of DUB.

Yes, the levonorgestrel-releasing intrauterine system (LNG-IUS), such as Mirena, is considered one of the most effective long-term medical treatments for heavy menstrual bleeding. It also provides excellent contraception and is a fertility-sparing option.

Yes, combined oral contraceptives (COCs) are a common and effective treatment for DUB, especially in adolescents. They regulate menstrual cycles and can reduce blood loss by 35% to 69% by stabilizing the uterine lining.

Yes, non-hormonal options are available for women who prefer to avoid hormones or who are trying to conceive. These include tranexamic acid, which is taken only during menses, and nonsteroidal anti-inflammatory drugs (NSAIDs).

In cases of severe, acute bleeding, high-dose hormonal therapy is used to quickly stabilize the uterine lining and stop the hemorrhage. This may involve a high-dose regimen of combined oral contraceptives or, in a hospital setting, intravenous conjugated estrogen.

Surgical procedures are typically a last resort for DUB, considered when medical treatments have failed, are contraindicated, or not tolerated. Options include endometrial ablation to destroy the uterine lining or a hysterectomy to remove the uterus completely.

You should consider your age, whether you want to preserve fertility, if you need contraception, and the severity of your bleeding. It is important to discuss these factors with your healthcare provider to select the most appropriate and personalized treatment plan.