What is the first-line treatment for anovulatory and ovulatory dysfunctional uterine bleeding?

The first-line treatment for both anovulatory and ovulatory dysfunctional uterine bleeding is oral contraceptive pills. These medications are effective because they provide hormone regulation, which can help normalizing the menstrual cycle and reducing excessive bleeding.

In cases of anovulatory bleeding, the absence of ovulation leads to unopposed estrogen stimulation of the endometrium, resulting in inappropriate thickening and subsequent bleeding. Oral contraceptive pills help to stabilize the endometrial lining by providing both estrogen and progestin, promoting a regular shedding of the endometrial tissue, and minimizing the likelihood of heavy or irregular bleeding.

For ovulatory dysfunctional uterine bleeding, oral contraceptive pills can also help regulate menstrual cycles. They can reduce menstrual flow and alleviate associated symptoms like dysmenorrhea, making them a broad and effective first-line treatment for various forms of dysfunctional uterine bleeding.

While other treatments such as GnRH agonists and non-steroidal anti-inflammatory drugs do have their roles—GnRH agonists in cases requiring more hormonal manipulation and anti-inflammatory drugs for symptomatic relief—they do not address the underlying issues as comprehensively as oral contraceptive pills. Endometrial ablation is generally considered when other conservative measures fail and when the goal is to significantly