Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding

Lethaby, Anne; Cooke, Inez; Rees, Margaret

doi:10.1002/14651858.cd002126.pub3

Cited by 137 publications

(49 citation statements)

References 78 publications

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“…Heavy menstrual bleeding affects up to 30% of women in reproductive age and is therefore one of the most common reasons to consult a primary care provider [1][2][3][4]. Many treatment options exist, varying from medical therapy to surgery, such as endometrial ablation or hysterectomy [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review

Zandstra

Busser

Aarts

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly.

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Section: Introductionmentioning

confidence: 99%

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review

Zandstra

Busser

Aarts

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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“…In addition, rapid recovery after discontinuation of the treatment was seen. The LNG-IUS is an effective medical treatment for HMB, with it being advocated as the medical treatment of choice [38, 39]. It has the advantage of offering additional contraception and treatment “reversibility,” unlike endometrial ablation or hysterectomy.…”

Section: Resultsmentioning

confidence: 99%

Two Years Follow-Up of Patients with Abnormal Uterine Bleeding after Insertion of the Levonorgestrel-Releasing Intrauterine System

Çim

Soysal

Sayan

et al. 2017

Gynecol Obstet Invest

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Aim: To evaluate the efficacy and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) in the long-term treatment of heavy menstrual blood loss in women unrelated to intrauterine pathology. Methods: One hundred and six parous women aged 33–48 years with recurrent heavy menstrual bleeding (HMB) participated in this study. The women were followed up for 24 months and were assessed for intensity of bleeding both for pre- and post-insertion periods. An LNG-IUS was inserted in each patient within 7 days of the start of menstrual flow. The women were followed up at 1, 3, 6, 12, 18, and 24 months following the insertion of the intrauterine device. Results: One hundred and two women completed the follow-up period and had a significant reduction in the amount of menstrual blood loss. The LNG-IUS was well tolerated by all women. Pre-treatment of the use of the LNG-IUS, endometrial biopsy patterns for irregular proliferative endometrium and for atypical simple hyperplasia were 34/106 (32.08%) and 61/106 (57.55%) respectively and after treatment no abnormal pathologic findings were determined (p < 0.001). Conclusion: Our findings indicate that the LNG-IUS is effective for significantly reducing the amount of menstrual blood loss in women with HMB.

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“…Однако существует ряд преимуществ использования трансдермального 17β-эстрадиола в сочетании с лнг-вМс, что позволяет расширить возможности для индивидуализации и безопасности МгТ. данная схема МгТ высокоэффективна у женщин с метроррагиями и гиперпластическими процессами эндометрия в анамнезе, что согласуется с данными Кокрейновского систематического обзора (2015), в котором при применении лнг-вМс зафиксированы более высокие показатели по сравнению с терапией пероральными прогестагенами для лечения аномальных маточных кровотечений [9]. Эксперты Эндокринологического общества по менопаузальным расстройствам считают, что лнг-вМс является эффективным средством для профилактики гиперплазии и рака эндометрия, особенно у женщин с ожирением [10].…”

Section: заключениеunclassified

Efficiency of the combination of transdermal estrogens and a hormone-releasing intrauterine system for the correction of menopausal symptoms

et al. 2020

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Hypothesis/aims of study. The aim of this study was to assess the efficiency of Mirena (levonorgestrel-releasing intrauterine system) combined with EstroGel (17-estradiol transdermal gel) being applied in the test group of peri- and postmenopausal women as menopausal hormonal therapy. Study design, materials and methods. The study involved 62 patients aged 42 to 55 years. The main group included 33 women who were prescribed Mirena in combination with EstroGel. The control group consisted of 29 women who were prescribed a combined two-phase tablet preparation containing micronized 17-estradiol as an estrogen component and dydrogesterone as a gestagen component. The condition of the patients was evaluated at the beginning of therapy and after 3, 6 and 12 months. Results. During therapy, patients in the main group decreased climacteric symptoms and improved lipid profile and blood biochemical parameters characterizing the hepatobiliary system. Patients in the control group had a comparable decrease in menopausal symptoms; however, there were changes in biochemical parameters, such as hypertriglyceridemia and a significant increase in bilirubin and transaminases, which required discontinuation of therapy. All the patients using Mirena in combination with EstroGel demonstrated good tolerability, efficiency of the therapy and no significant symptoms requiring its withdrawal. During the menopausal hormonal therapy, there were no cases of relapse of endometrial hyperplasia, growth of myomatous nodes and an increase in endometriosis prevalence. Patients in the control group during the first three months of therapy noted acyclic spotting, breast engorgement and tenderness, headaches, and exacerbation of cholelithiasis, which resulted in decreased adherence to therapy. Conclusion. The use of estrogen transdermally in combination with the intrauterine administration of levonorgestrel is an effective and safe method that helps to relieve menopausal symptoms and to improve the health and quality of life of women with extragenital pathology, endometrial and mammary gland hyperplastic processes, endometriosis, and menometrorrhagia.

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Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding

Abstract: Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding (Review)

Cited by 137 publications

References 78 publications

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review

Two Years Follow-Up of Patients with Abnormal Uterine Bleeding after Insertion of the Levonorgestrel-Releasing Intrauterine System

Efficiency of the combination of transdermal estrogens and a hormone-releasing intrauterine system for the correction of menopausal symptoms

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