What is the drug of choice for controlling mild abnormal uterine bleeding in a 25-year-old woman with future childbearing plans?

• A. Estrogen only
• B. Androgen therapy
• C. Gonadotropin-releasing hormone analogs
• D. Progesterone only

Answer: (D)

The most appropriate choice for managing mild abnormal uterine bleeding in a 25-year-old woman who wishes to preserve her fertility is progesterone only. Progesterone plays a crucial role in the menstrual cycle and can help regulate and stabilize the endometrium, thereby reducing abnormal bleeding.

In cases of mild abnormal uterine bleeding, especially in premenopausal women, the use of progesterone can help counteract the effects of unopposed estrogen, which may contribute to the thickening of the endometrial lining and excessive bleeding. Additionally, because the patient is planning future pregnancies, using progesterone is advantageous as it does not compromise fertility.

Other treatments, like estrogen only, might be more suitable in different contexts but can pose risks such as endometrial hyperplasia if not balanced with progesterone, especially in women who still have their uterus. Androgen therapy is generally not indicated for abnormal bleeding and can lead to side effects that may impact quality of life. Gonadotropin-releasing hormone analogs are primarily used for more serious conditions such as endometriosis or fibroids and are not first-line for mild bleeding as they may induce a hypoestrogenic state that is not desirable for a woman wishing to conceive in the future