Combined hormonal contraceptives for heavy menstrual bleeding

Area of Science:

• Gynecology
• Reproductive Medicine
• Pharmacology

Background:

• Heavy menstrual bleeding (HMB) significantly impairs women's quality of life.
• Medical treatments for HMB include hormonal therapies and non-steroidal anti-inflammatory drugs.
• Combined hormonal contraceptives, such as oral contraceptive pills (COCP) and contraceptive vaginal rings (CVR), are used for HMB management.

Purpose of the Study:

• To evaluate the efficacy of combined hormonal contraceptives (COCP, CVR, patch) for treating HMB.
• To compare the effectiveness of COCP against other medical treatments, placebo, or no therapy.
• To specifically compare the efficacy of COCP and CVR.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through extensive database searches.
• Included RCTs compared COCP or CVR with placebo, no treatment, or other medical therapies for HMB.
• Primary outcomes included treatment success, menstrual bleeding reduction, and participant satisfaction; secondary outcomes were adverse events and quality of life.

Main Results:

• COCP demonstrated moderate-quality evidence of significantly reducing HMB and improving treatment success compared to placebo.
• The levonorgestrel-releasing intrauterine system (LNG IUS) was found to be more effective in reducing MBL than COCP (low-quality evidence).
• Limited evidence suggested comparable efficacy between COCP and CVR, with COCP associated with a higher likelihood of nausea.

Conclusions:

• Combined oral contraceptive pills (COCP) are effective in reducing heavy menstrual bleeding (HMB) compared to placebo.
• The levonorgestrel-releasing intrauterine system (LNG IUS) shows superior efficacy over COCP for HMB management.
• Further research is needed to establish the comparative efficacy of combined hormonal contraceptives against NSAIDs and long-course progestogens due to insufficient evidence.