Intervention Review

Cyclical progestogens for heavy menstrual bleeding

  1. Anne Lethaby1,*,
  2. Gill A Irvine2,
  3. Iain T Cameron3

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 24 SEP 2007

DOI: 10.1002/14651858.CD001016.pub2


How to Cite

Lethaby A, Irvine GA, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001016. DOI: 10.1002/14651858.CD001016.pub2.

Author Information

  1. 1

    School of Population Health,University of Auckland, Section of Epidemiology & Biostatistics, Auckland, New Zealand

  2. 2

    Ayrshire Central Hospital, Obstetrics and Gynaecology, Irvine, Ayrshire, UK

  3. 3

    University of Southampton, Princess Anne Hospital, Department of Obstetrics and Gynaecology, Southampton, UK

*Anne Lethaby, Section of Epidemiology & Biostatistics, School of Population Health,University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. a.lethaby@auckland.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Excessively heavy menstrual bleeding (HMB) or menorrhagia is an important cause of ill health in women. Eighty per cent of women treated for HMB have no anatomical pathology, which makes medical therapy, with the avoidance of possibly unnecessary surgery, an attractive alternative. Of the wide variety of medications used to reduce heavy menstrual bleeding, oral progestogens are the most commonly prescribed. This review assesses the effectiveness of two different regimens of oral progestogens in reducing ovulatory HMB.

Objectives

The primary objective of this review was to investigate the effectiveness of oral progestogen therapy taken either during the luteal phase or for a longer course of 21 days in achieving a reduction in menstrual blood loss in women of reproductive years with heavy menstrual bleeding (HMB).

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched April 2007), MEDLINE (1966 to April 2007) and EMBASE (1985 to April 2007). Attempts were also made to identify trials from citation lists of review articles. In most cases, the first author of each included trial was contacted.

Selection criteria

The inclusion criteria were randomised comparisons of oral progestogen therapy versus placebo or other medical treatments in women of reproductive years with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic causes for their heavy menstrual blood loss.

Data collection and analysis

Seven randomised controlled trials (RCTs) were identified that fulfilled the inclusion criteria. The review authors extracted the data independently. Odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes were estimated from the data.

Main results

No RCTs comparing progestogen treatment with placebo were identified. Comparisons between oral progestogens and other medical therapies were assessed separately according to dosage regimen.

Progestogen therapy during the luteal phase was significantly less effective at reducing menstrual blood loss when compared with tranexamic acid, danazol and the progesterone-releasing intrauterine system (IUS). Duration of menstruation was significantly longer with the progesterone IUS when compared with oral progestogen therapy but significantly shorter with danazol treatment. Adverse events were significantly more likely with danazol when compared with progestogen treatment. Progestogen therapy from day 5 to day 26 of the menstrual cycle was significantly less effective at reducing menstrual blood loss than the IUS. A significantly higher proportion of norethisterone (NET) patients taking progestogens found their treatment unacceptable compared to IUS patients. However, the adverse effects of breast tenderness and intermenstrual bleeding were more likely in women with the IUS.

Authors' conclusions

Progestogens administered from day 15 or 19 to day 26 of the cycle offer no advantage over other medical therapies such as danazol, tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs) and the IUS in the treatment of menorrhagia in women with ovulatory cycles. Progestogen therapy for 21 days of the cycle results in a significant reduction in menstrual blood loss, although women found the treatment less acceptable than intrauterine levonorgestrel. This regimen of progestogen may have a role in the short-term treatment of menorrhagia.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Cyclical progestogens for heavy menstrual bleeding

Progestagens may offer some help in reducing heavy menstrual bleeding but are not as effective as other therapies such as danazol and tranexamic acid. Heavy menstrual bleeding (HMB) is when a woman looses 80 ml or more of blood per menstrual cycle (period). Most women with HMB do not show any physical cause so getting help without surgery is an attractive alternative. Progestogens are taken by mouth either during days 15 or 16 to day 26 of the menstrual cycle (short course) or from day 5 to day 26 (long course). The review of trials found that progestogens significantly reduced menstrual blood loss but were less effective than danazol, tranexamic acid and the progesterone-releasing intrauterine system (IUS).

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

週期性黃體酮(progestogens)用於經血量過多

經血量過多,對於婦女而言就是1種會危害健康的重要原因。百分之80%因大量月經出血而接受治療的婦女之中,是沒有結構上的異常的。所以,為了能夠避免掉可能不必要的手術,藥物治療因此成為1種具有吸引力的選項。在這些被用來減少大量月經出血時所選擇的眾多不同藥物之中,醫師們最常開立的藥物就是口服的黃體酮。本篇回顧評估了針對排卵型經血量過多的二種黃體素用藥方法及療效。

目標

本篇回顧的目標在於比較僅於黃體期使用口服黃體酮或延長使用黃體酮超過21天,對於適育年齡婦女經血量過多的治療效果。

搜尋策略

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group Trials Register (2007年4月搜尋) 、 MEDLINE (1966年2007年4月) 以及EMBASE (1985年2007年4月) 。並試著由回顧文章的參考文獻清單找出試驗;並且聯絡了多數納入試驗的第一作者。

選擇標準

納入的標準是隨機比較的試驗,比較口服型黃體酮類藥物相較於安慰劑或其他藥物對於沒有結構上或醫療性問題,主觀或客觀有經血量過多問題的適孕年齡婦女的治療效果。

資料收集與分析

對於要完全符合收集的標準而言,我們總共確認了7組合格的隨機對照試驗(RCTs)。這些審稿的作者都獨立地擷取出資料。對於二元性的結果所用的勝算比(Odds ratios),以及對於連續性結果所用的加權平均差(weighted mean differences),都是從這些資料中估算出來的。

主要結論

在已獲得確認的隨機對照試驗當中,並沒有任何項目曾針對黃體酮治療與安慰劑來進行比較。在口服型黃體酮類藥物與其他藥物治療法之間,相關的比較都是根據不同的劑量,分開進行評估。若是跟 tranexamic acid、 danazol ,以及釋放黃體酮的子宮內投藥系統(intrauterine system,IUS)等項目比較起來,僅在黃體期使用的黃體酮,對於減少月經量,有意義的較不具功效。若是跟口服型的黃體內泌素比較起來,使用黃體酮的子宮內投藥系統時,月經持續的時間會明顯地變得比較長,但若是跟 danazol治療比較起來,使用黃體酮的子宮內投藥系統時,月經持續的時間卻又明顯地變得比較短。若是跟黃體內泌素治療比較起來,使用danazol會明顯地造成比較多的不良反應。跟使用子宮內投藥系統比較起來,從月經週期的第5天到第26天使用的黃體酮,對於經血量的減少的效果顯著較差。跟使用子宮內投藥系統的患者比較起來,使用 norethisterone(NET)的患者,明顯地有較高比例感到無法接受她們的治療方法。然而,在使用了子宮內投藥系統的婦女們身上,卻比較容易發生胸部觸痛與非月經期出血的的現象。

作者結論

對於有排卵週期的婦女而言,在治療經血量過多的方面,跟其他像是danazol、tranexamic acid、非固醇類消炎藥(nonsteroidal antiinflammatory drugs,NSAIDs),以及子宮內投藥系統等等醫學療法比較起來,從週期的第15天或是第19天到第26天的期間,給予黃體酮類的藥物並沒有任何優點。雖然週期性使用21天的黃體酮對於降低月經出血量有明顯的幫忙,但相較於子宮內投藥系統,婦女的接受度較低。在短期治療月經血量過多的問題時,這樣的黃體酮治療方法可能會扮演著某種角色。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

在減少月經時大量出血的問題上,週期性使用黃體酮類藥物或許能夠提供某些幫助,但是它們的功效卻比不上其他的療法,像是danazol與 tranexamic acid。大量的月經出血(HMB)指的是某位婦女在每次月經週期(期間)的時候,流失的血液量達到80毫升或是更多。大多數發生大量月經出血的婦女,都沒有表現出任何的生理成因,所以要是在不接受手術的前提下而能夠獲得幫助,就成了1種具有吸引力的其他選項。黃體酮類藥物必須要每個月服用,可以選在月經週期之第15天或第16天到第26天的這段期間(短期程),或是從第5天到第26天(長期程)。本篇試驗的回顧發現,黃體酮類的藥物可以明顯地減少月經時的血液流失量,但是在功效上卻不如danazol、tranexamic acid,以及釋放黃體酮的子宮內投藥系統(IUS)。