Combined hormonal contraceptives for heavy menstrual bleeding

Abstract

Background Menorrhagia or heavy menstrual bleeding (HMB) is an excessive blood loss that impairs a woman's quality of life, either physical, emotional, social or material. It is benign and not associated with pregnancy or any other gynaecological or systemic disease. Medical treatments used to reduce excessive menstrual blood loss (MBL) include prostaglandin synthetase inhibitors, antifibrinolytics, oral contraceptive pills, and other hormones. The combined oral contraceptive pill (COCP) is claimed to have a variety of beneficial effects, inducing a regular shedding of a thinner endometrium and inhibiting ovulation, thus having the effect of both treating HMB and providing contraception. More recently, a contraceptive vaginal ring (CVR) has been trialled to investigate whether this treatment can provide similar benefits to COCP while lessening hormonal systemic exposure. This review is an update of a review which originally focused on COCP alone. The scope of the review has been widened to consider other types of delivery of combined hormonal contraceptives for reduction of MBL. Objectives To determine the efficacy of combined hormonal contraceptives (pills, vaginal ring or patch) compared with other medical therapies, placebo, or no therapy in the treatment of HMB. A secondary objective was to compare the COCP with the CVR.

The role of levonorgestrel intra‐uterine system in the management of adenomyosis: A systematic review and meta‐analysis of prospective studies

“…In the present review, one included study reported that the LNG‐IUS was more effective than COC in terms of bleeding and pain among patients with adenomyosis. Similarly, a recent Cochrane review on eight trials reported that LNG‐IUS was associated with a greater reduction in bleeding compared with COC in women with heavy menstrual bleeding . As mentioned before, hysterectomy is the only definitive therapy for adenomyotic lesions.…”

Two-Pronged Treatment of Hemoperitoneum and Abnormal Uterine Bleeding in an Adolescent Girl With Congenital Fibrinogen Deficiency

“…Regarding ovulation suppression, COC can achieve significant results. However, the effect of reducing menstruation is unsatisfactory: the treatment success rate is from 36.8% (13) to 68% (14). In our case, the patient's repeated history of hypermenorrhea with hospitalization discouraged her parents from assuming such a high risk of failure, whether it was for economic or spiritual considerations, they refused to try COC treatment and planned to have her uterus removed to completely cure her AUB-C.…”

“…On the one hand, the estrogen component in COC prevents follicle-stimulating hormone secretion and the development of a dominant follicle, and the progestogen prevents the luteinizing hormone surge and ovulation, which will avoid the rupture of the follicle and corpus luteum from the root cause. On the other hand, the progestogen creates an atrophic endometrial lining, that reduces overall blood loss at the time of menstruation (14). Regarding ovulation suppression, COC can achieve significant results.…”

“…However, hysterectomy would forever deprive our patient of childbearing. According to the relevant literature (13,14,20,21), LNG-IUS is more effective than COC at reducing overall menstrual blood loss and reaching menstrual "normality." Therefore, after full communication with her family about the related advantages and complications, LNG-IUS combined with COC was used for the patient's long-term management.…”

Hormonal Contraception

“…Heavy Menstrual Bleeding (HMB) Early anecdotal evidence, but only few randomized trials (Lethaby et al 2019), strongly support the impact of COC on reducing menstrual bleeding volume and preventing the risk of secondary anemia. COC at different dosages are used in the management of dysfunctional heavy menstrual bleeding from menarche but also in adenomyosis, leiomyomas, and hemostasis disorders.…”