Intervention Review

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Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

  1. Hany Abdel-Aleem1,*,
  2. Catherine d'Arcangues2,
  3. Kirsten M Vogelsong3,
  4. Mary Lyn Gaffield4,
  5. A Metin Gülmezoglu5

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 21 OCT 2013

Assessed as up-to-date: 15 MAY 2012

DOI: 10.1002/14651858.CD003449.pub5


How to Cite

Abdel-Aleem H, d'Arcangues C, Vogelsong KM, Gaffield ML, Gülmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003449. DOI: 10.1002/14651858.CD003449.pub5.

Author Information

  1. 1

    Assiut University Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut, Assiut, Egypt

  2. 2

    Own Consultancy, Prevessin-Moens, France

  3. 3

    Bill and Melinda Gates Foundation, Seattle, Washington, USA

  4. 4

    World Health Organization, Department of Reproductive Health and Research, Geneva 27, Switzerland

  5. 5

    World Health Organization, UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, Geneva, Switzerland

*Hany Abdel-Aleem, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University Hospital, Assiut, Assiut, 71511, Egypt. hany.abdelaleem@yahoo.com. haleem@aun.edu.eg.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 OCT 2013

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Abstract

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

Background

Despite their high effectiveness, progestin-only contraceptives are considered less than ideal by the many women who experience irregular vaginal bleeding when using them. Current treatments to control these bleeding problems are not sufficiently effective.

Objectives

We evaluated preventive and therapeutic approaches to normalise bleeding irregularities associated with the use of progestin-only contraceptives.

Search methods

Literature was identified through database searches, reference lists, organisations and individuals, covering the period until May-June 2012.

Selection criteria

Trials with random or systematic allocation, testing interventions for the prevention or treatment of bleeding irregularities associated with the use of progestin-only contraceptives were eligible.

Data collection and analysis

Results are expressed as relative risks (RR) with 95% confidence interval (CI) for categorical data and as weighted mean difference (WMD) with 95% CI for continuous data. When we encountered heterogeneity (visual or statistical) we used the random-effects model (quantitative) or did not produce a summary estimate (qualitative).

Main results

Thirty-three randomised controlled trials enrolling 3677 participants were included. Two thirds of the trials were determined to reflect low to moderate risk of bias.

Estrogen treatments reduced the number of days of an ongoing bleeding episode in DMPA and Norplant users. However, treatment frequently led to more discontinuation due to gastrointestinal upset.

Combinations of oral ethinyl estradiol and levonorgestrel improved bleeding patterns in Norplant users, but method discontinuation rates were unchanged. 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 reported fewer days of bleeding during treatment than those given placebo. Mifepristone used monthly by new Norplant acceptors reduced bleeding, when compared to placebo.

A variety of NSAIDS have been evaluated for their ability to treat abnormal bleeding, with mixed results.

Norplant users receiving SERM (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.

Authors' conclusions

Some women may benefit from the interventions described, particularly with cessation of current bleeding. Several regimens offer promise in regulating bleeding, but findings need to be reproduced in larger trials. The results of this review do not support routine clinical use of any of the regimens included in the trials, particularly for long-term effect.

 

Plain language summary

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

Evaluation of treatments for vaginal bleeding induced by progestin-only contraceptives

As the use of progestin-only methods of contraception continues to increase worldwide, the problem of vaginal bleeding disturbances these methods induce is becoming of increasing public health relevance.Since this adverse effect limits method's acceptability, and leads to loss of compliance. Some women may benefit to some degree from some interventions tested. However the evidence reviewed is not strong enough to recommend routine use of any of the regimens included in the trials, particularly for long-term effects. Positive results need to be reproduced in larger scale trials.