Progestogens versus oestrogens and progestogens for irregular uterine bleeding associated with anovulation

Area of Science:

• Reproductive Endocrinology
• Gynecology

Background:

• Dysfunctional uterine bleeding (DUB) is characterized by abnormal uterine bleeding not caused by pregnancy or other diseases.
• Anovulation, often assumed in cases of irregular or heavy bleeding, disrupts the hypothalamo-pituitary-ovarian (HPO) axis.
• Hormonal imbalances, particularly acyclic estrogen production, lead to irregular endometrial buildup and bleeding, necessitating progestogen intervention.

Purpose of the Study:

• To evaluate the effectiveness and acceptability of progestogen monotherapy and combined estrogen-progestogen therapy for anovulatory irregular uterine bleeding.

Main Methods:

• A systematic search of randomized trials was conducted using the Menstrual Disorders Group strategy and the Cochrane Controlled Trials Register.
• Included were all randomized controlled trials investigating progestogens alone or with estrogens for irregular bleeding due to anovulation.
• Study quality assessment and data extraction were performed independently by two subject matter experts.

Main Results:

• No randomized trials were found comparing progestogens with combined estrogen-progestogen therapy for anovulatory irregular bleeding.
• One small, non-randomized study compared two progestogen regimens for heavy and irregular bleeding in anovulatory subjects.
• A single randomized study examined progestogen effects on endometrial histology in women with various menstrual symptoms, including cystic glandular hyperplasia.

Conclusions:

• There is a significant lack of randomized studies on progestogens and combined estrogen-progestogen therapies for irregular bleeding associated with anovulation.
• Further research is essential to establish the optimal role of these hormonal treatments in managing this prevalent gynecological condition.