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Cyclical progestogens for heavy menstrual bleeding.

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Oral progestogens for heavy menstrual bleeding (HMB) were found to be less effective than other treatments. Both short-cycle and long-cycle progestogen therapies showed inferiority compared to alternatives like tranexamic acid and LNG-IUS.

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Area of Science:

  • Gynecology and Fertility
  • Pharmacology
  • Reproductive Health

Background:

  • Heavy menstrual bleeding (HMB) significantly impacts women's quality of life.
  • Medical management is the first-line therapy for HMB, often involving oral progestogens.
  • This review evaluates oral progestogen effectiveness for ovulatory HMB.

Purpose of the Study:

  • To assess the effectiveness, safety, and tolerability of oral progestogen therapy for reducing menstrual blood loss in women with HMB.
  • To compare short-cycle (luteal phase) versus long-cycle (21 days) progestogen regimens.

Main Methods:

  • Systematic review and meta-analysis of 15 randomized controlled trials (RCTs) involving 1071 women.
  • Searched multiple databases including Cochrane, MEDLINE, Embase, CINAHL, and PsycINFO up to January 2019.
  • Primary outcomes: menstrual blood loss and treatment satisfaction; secondary outcomes: bleeding days, quality of life, compliance, acceptability, adverse events, and costs.

Main Results:

  • Short-cycle progestogen therapy was inferior to other medical therapies (tranexamic acid, danazol, Pg-IUS) in reducing menstrual blood loss.
  • Long-cycle progestogen therapy was also inferior to LNG-IUS, tranexamic acid, and ormeloxifene, but comparable to the combined vaginal ring.
  • Evidence quality was low to very low, indicating uncertainty in findings.

Conclusions:

  • Low-quality evidence suggests both short- and long-cycle oral progestogen therapies are less effective for reducing menstrual blood loss compared to several other medical treatments.
  • The effectiveness of oral progestogens for HMB is limited, with newer treatments often showing superior outcomes.
  • Further research is needed to clarify the role of progestogens, given the low-quality evidence.