A Cochrane review [Abstract] 1 included 33 studies with a total of 3677 subjects. Estrogen treatments reduced the number of days of an ongoing bleeding episode in DMPA and Norplant users. However, treatment frequently led to discontinuation due to gastrointestinal upset.
Combinations of oral ethinyl estradiol and levonorgestrel taken by Norplant users experiencing bleeding irregularities, improved bleeding patterns but method discontinuation rates remained the same. One trial reported successful use of combined oral contraceptives in treating amenorrhea among DMPA users.
Norplant users, but not Implanon users, administered the anti-progestin mifepristone therapeutically reported fewer days of bleeding than those given placebo. Prophylactic oral mifepristone used monthly by new Norplant users reduced bleeding, when compared to placebo.
A variety of NSAIDS have been evaluated for their ability to treat abnormal bleeding, with mixed results; ibuprofen, mefenamic acid and valdecoxib showing benefits and aspirin no effect on bleeding patterns.
Norplant users receiving tamoxifen had less unacceptable bleeding after treatment and were more likely to continue using Norplant than those receiving placebo.
Tranexamic acid, mifepristone combined with an estrogen and doxycycline were more effective than placebo in terminating an episode of bleeding in women using progestin-only contraceptives, according to three small studies.
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment) and by imprecise results (few studied patients in each comparison).
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