Combined hormonal contraceptives for heavy menstrual bleeding

This is an updated Cochrane Review, scope of which was changed to include all combined hormonal contraception as the intervention, regardless of mode of administration. New updated searches were performed in July 2017 and September 2018, after which 7 new studies were identified. The change of scope and addition of 7 new studies have led to a change in the conclusion of this updated review. The initial review was published in 2009 and focused on combined oral contraceptive pill (COCP) alone.

The primary objective of the study was to determine the efficacy of combined hormonal contraceptives such as pills, vaginal rings, or patch, compared with other medical therapies, placebo, or no therapy in the treatment of heavy menstrual bleeding (HMB). The secondary objective was to compare the COCP with the contraceptive vaginal ring (CVR).

• 2 studies found that a type of COCP, containing estradiol valerate and dienogest, reduced HMB and improved quality of life and haemoglobin levels when compared with placebo, but at the expense of some minor side effects
• there was insufficient evidence to compare contraceptives with other treatments, such as nonsteroidal anti-inflammatories or progestogens
• 2 studies found that the levonorgestrel-releasing intrauterine system (LNG IUS) was more effective than the COCP at reducing menstrual blood loss
• 2 trials found no evidence of different effects between the oral contraceptive pill or the hormonal vaginal ring
• there were no studies found that assessed the effects of the combined hormonal patch (transdermal patch)

Bottom line of the review is that although it is likely that combined hormonal contraceptives can reduce HMB, there is no absolute certainty how they compare with other medical treatments for reducing HMB, although LNG IUS appears to be more effective.

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.