Patient education
Hormonal tablets for abnormal uterine bleeding (AUB)
Hormonal tablets can reduce heavy or irregular bleeding, improve anaemia, and make cycles more predictable. The “right” tablet depends on your bleeding pattern, the likely cause, your medical profile, and whether contraception is also a goal.
One size does not fit all
Hormonal tablets come in different formulations, doses, and ways of taking them. What makes the biggest difference is matching the pill to your symptoms, risks, and goals and then adjusting intelligently if your body doesn’t love the first choice.
If your bleeding is heavy enough to cause fatigue, dizziness, or iron deficiency, don’t just “push through”. There are effective options.
Where tablets fit
Hormonal tablets are commonly used to treat abnormal uterine bleeding, especially when the goal is to reduce bleeding, improve cycle predictability, or treat bleeding driven by hormonal imbalance (for example, irregular or anovulatory cycles). They can be used on their own, or as part of a stepwise plan while we evaluate the underlying cause.
Key idea: the best option depends on what we’re treating. Bleeding from fibroids or polyps is managed differently from bleeding driven by ovulation problems or perimenopausal hormone variability.
Tablet options
There are two main categories of hormonal tablets we use for AUB: combined tablets (oestrogen + progestin) and progestin-only regimens (typically higher-dose progestins used for bleeding control).
Combined tablets (oestrogen + progestin)
Often improves bleeding volume, cycle regularity, and period pain. Can be used in a monthly pattern or in some cases continuously to reduce the number of bleeds per year.
- Best for: cycle control + contraception when oestrogen is safe
- Typical benefits: lighter, more predictable bleeding
Progestin-only regimens (for bleeding control)
For AUB we often use specific progestins and specific doses aimed at stabilising the endometrium. These are different from the very-low-dose “mini-pill” used mainly for contraception.
- Best for: irregular/anovulatory bleeding, endometrial protection, or when oestrogen isn’t suitable
- Typical benefits: fewer unpredictable bleeds over time
How I choose the right pill
There isn’t one pill that works for everyone. Hormonal tablets differ in three important ways: the type of hormone, the dose, and the pattern of use. These differences affect how well bleeding improves, how your body feels on the tablet, and whether it fits your goals (bleeding control, cycle predictability, contraception, or fertility planning).
What makes this different in my practice: I individualise treatment. I match the combination, type, and dose to the patient in front of me and adjust based on response. The goal is not just “a pill”, but a plan that works and feels manageable.
Step 1
Clarify the pattern
Heavy vs irregular? Predictable cycles vs spotting? Pain? Bleeding with sex? These clues matter.
Step 2
Check safety
We confirm what is safe for you (for example, whether oestrogen is appropriate) and what to avoid.
Step 3
Target the cause
If ultrasound suggests fibroids/polyps/adenomyosis, tablets may be part of a bigger plan rather than the only step.
Step 4
Review and refine
We set expectations, review response, and adjust if needed rather than simply giving up or escalating too soon.
Who should use which option
Combined tablets may suit you if…
- You want contraception as well as bleeding control
- You want predictable cycles or fewer bleeds (with extended use)
- Oestrogen is safe for you
Progestin-only regimens may suit you if…
- Your bleeding is irregular/anovulatory and the lining needs stabilising
- Endometrial protection is a priority
- Oestrogen isn’t suitable for you, or you prefer to avoid it
Not sure where you fit? That’s normal. The goal is to choose safely, set realistic expectations, and then review response. If bleeding persists, we don’t just keep repeating the same plan. We reassess and escalate thoughtfully.
What to expect
How fast does it work?
Some improvement can be seen in the first cycle, but things often settle over 1–3 cycles. Early spotting or breakthrough bleeding can happen, especially when starting or changing regimens.
Will I still need tests?
Sometimes, yes. If bleeding is heavy, persistent, new, or associated with risk factors, we may need ultrasound and occasionally sampling of the lining. Treatment and investigation often happen together.
What if it doesn’t help enough?
Then we adjust. That could mean changing formulation/dose, switching strategy, adding a non-hormonal option, or treating an underlying structural cause such as a polyp or fibroid.
Side effects & safety
Most side effects are mild and often improve after the settling-in phase. The important part is matching the option to your medical history, especially when oestrogen is involved.
Common side effects
- Nausea, breast tenderness, headaches (more common with oestrogen-containing tablets)
- Mood changes, bloating, acne, appetite changes (can happen with progestins)
- Breakthrough bleeding, especially early on or if pills are missed
When we’re more cautious
Some patients should avoid oestrogen-containing tablets due to clotting or stroke risk, certain migraine patterns, uncontrolled blood pressure, and other medical factors. We’ll choose the safest option for you.
If bleeding is suddenly very heavy
If you are soaking through pads hourly for several hours, passing large clots, feeling faint, short of breath, or you’re worried you may be anaemic, you need urgent assessment. Some acute bleeding episodes can be managed with short-course medication, but safety comes first and the correct approach depends on your stability and individual risks.
If you feel unsafe: seek same-day care at an emergency unit.
More detail in the contraception hub
If you want the deeper dive on tablet types, dosing patterns, and contraceptive-specific details, use these links:
Book an assessment
If your bleeding is affecting quality of life, causing fatigue or low iron, or you’re just tired of guessing, we can build a plan that matches your goals. I’ll also screen for red flags and make sure we’re not missing an underlying cause.
Medical content is general education and not a substitute for individual assessment.