Combined Oral Contraceptive Pills Versus Progestin-Only Pills for Heavy Menstrual Bleeding: A Systematic Review

Heavy menstrual bleeding (HMB) is a common gynecological condition among women of reproductive age that significantly affects quality of life and often leads to iron deficiency anemia. Hormonal treatments are usually prescribed in combination to include combined oral contraceptives (COCs) and progestin-only pills (POPs) in treating HMB. This systematic review aims to compare the effectiveness and safety of COCs and POPs in the management of HMB in terms of menstrual blood loss, hemoglobin levels, side effects, and patient satisfaction. The literature search was conducted on PubMed, Scopus, Web of Science, and Google Scholar and covered articles published between 2000 and 2025. Blood loss reduction, hemoglobin levels, side effects, and patient satisfaction data were extracted, and a narrative review was conducted. The review included 10 studies. Both POPs and COCs had a great impact on minimizing menstrual blood loss and enhancing hemoglobin index. There were no mean differences in the two treatments concerning the improvement of hemoglobin, with a mean change of 2.75-2.71 g/dL in both treatment groups (p = 0.84). The heterogeneity within the companies made the calculation of confidence intervals impossible, and the comparison was done regarding the differences in mean only. COCs were linked with an increased incidence of nausea, headaches, and weight gain, whereas POPs were found to have more desirable side effects. Drospirenone (POP) showed reduced unscheduled bleeding days and patient satisfaction with the medication compared to other POPs. Risk of bias was moderate to low across studies, with some concerns regarding randomization and blinding in certain trials. Further research with larger sample sizes, longer follow-up periods, and head-to-head comparisons between COCs and POPs is needed to confirm these findings and evaluate the long-term impact of these treatments.