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Evidence summaries

Cyclical Progestogens for Heavy Menstrual Bleeding

Progestogens administered from day 15 or 19 to 26 of the cycle probably offer no advantage over tranexamic acid, danazol or NSAIDs, and the progestagen-releasing intrauterine system in the treatment of menorrhagia in women with ovulatory cycles. Progestagen therapy for 21 days is less acceptable to patients than the intrauterine levonorgestrel-releasing system. Level of evidence: "C"

Among the 15 trials included in a Cochrane review [Abstract] 1 including a total of 1071 subjects there were no RCTs comparing progestogens with placebo. Progestogen therapy during the luteal phase was significantly less effective at reducing menstrual blood loss when compared to tranexamic acid, danazol and the progesterone-releasing intrauterine system. There was also a strong non-significant trend in favour of NSAIDs. Adverse events were more likely with danazol. Change in quality of life was slightly (not significantly) better with tranexamic acid. Progestogen therapy administered from day 5 to 26 of the menstrual cycle was significantly less effective at reducing menstrual blood loss than the progestogen-releasing intrauterine system (LNG IUS), although the reduction from baseline was significant in both groups. A significantly higher proportion of norethisterone-treated patients found their treatment unacceptable compared to LNG IUS patients. However, the adverse events breast tenderness and intermenstrual bleeding, were more likely in the patients with the IUS.

Comment: The quality of evidence is downgraded by sparse data and heterogeneity in interventions and outcomes.

    References

    • Bofill Rodriguez M, Lethaby A, Low C et al. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev 2019;(8):CD001016.[PubMed]

Primary/Secondary Keywords