Progestogen-releasing intrauterine systems for heavy menstrual bleeding

Rodriguez, Magdalena Bofill; Lethaby, Anne; Jordan, Vanessa

doi:10.1002/14651858.cd002126.pub4

Cited by 43 publications

(45 citation statements)

References 98 publications

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“…While OCs in general can achieve reduction of 35-68% [17,18], a quadriphasic combined OC, containing oestradiol valerate and dienogest, can decrease blood loss over seven cycles by a median of 88% and is the only oral contraceptive approved for the treatment of HMB [19]. The 52 mg LNG-IUS is the most effective medical treatment for HMB, achieving a greater reduction in MBL, improved quality of life, and better long-term patient acceptance than OCs [1,4]. The 52 mg LNG-IUS was demonstrated to reduce MBL by around 95% over six cycles [20,21].…”

Section: Differences and Similarities In Relation To Other Studiesmentioning

confidence: 99%

“…Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that affects a woman's physical, emotional, social, and material quality of life [1]. The prevalence of HMB among women of reproductive age ranges from 10% to 30% and is influenced by the approach to assessment and the clinical setting, as well as cultural, social, and age-driven perceptions of what constitutes 'normal' menstruation [2,3].…”

Section: Introductionmentioning

confidence: 99%

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The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

Filho

Caetano

Lahav

et al. 2021

The European Journal of Contraception & Reproductive Health

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Purpose: Up to 30% of women of reproductive age experience HMB, which has a substantial impact on their quality of life. A clinical care pathway for women with HMB is an unmet need, but its development requires better understanding of the factors that characterise current diagnosis and management of the condition. Materials and methods: This observational, survey-based study assessed the burden, personal experiences, and path through clinical management of women with HMB in Canada, the USA, Brazil, France and Russia using a detailed, semi-structured online questionnaire. After excluding those reporting relevant organic pathology, responses to the questionnaire from 200 women per country were analysed. Results: Around 75% of women with HMB had actively sought information about heavy periods, mostly through internet research. The mean time from first symptoms until seeking help was 2.9 (Standard deviation, 3.1) years. However, 40% of women had not seen a health care professional about the condition. Furthermore, 54% had never been diagnosed or treated. Only 20% had been diagnosed and received appropriate treatment. Treatment was successful in 69% of those patients currently receiving treatment. Oral contraceptives were the treatment most commonly prescribed for HMB, although the highly effective levonorgestrel-intrauterine system was used by only a small proportion of women. Conclusions: This study provides insight into the typical journey of a woman with HMB which may help patients and health care professionals improve the path to diagnosis and treatment, although further research with long-term outcomes is needed.

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Section: Differences and Similarities In Relation To Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

Filho

Caetano

Lahav

et al. 2021

The European Journal of Contraception & Reproductive Health

View full text Add to dashboard Cite

show abstract

“…LNG-IUD has also been reported to reverse endometrial hyperplasia [ 128 ] and early endometrial carcinoma [ 129 , 130 ] in patients with PCOS. LNG-IUD has also been superior to both non-intrauterine progestins [ 131 ] and COCs [ 132 ] in reducing heavy menstrual bleeding. LNG-IUD is also effective in the treatment of endometriosis and associated pelvic pain [ 133 ].…”

Section: Progestin-only Contraceptivesmentioning

confidence: 99%

An Update on Contraception in Polycystic Ovary Syndrome

Oğuz

Yildiz

2021

Endocrinol Metab

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.

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“…If oral hormone treatment is not feasible or insufficient to control HMB, the levonorgestrel-releasing intrauterine system (LNG-IUS) is the most effective medical intervention in this setting, reducing the frequency of HMB and surgical treatments by at least 50%. [32][33][34] Especially in the presence of adenomyosis, uterine fibroids and endometriosis, the LNG-IUS reduces menstrual blood loss and pain associated with these conditions. 35 Levonorgestrel also reduces the endometrial proliferation, resulting in endometrial suppression.…”

Section: Covalent Modification Of the Fxaα Active Site Inhibits Cleavage Frommentioning

confidence: 99%

Reproductive issues in women on direct oral anticoagulants

Beyer‐Westendorf

Marten

2021

Research and Practice in Thrombosis and Haemostasis

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Direct oral anticoagulants (DOACs) are replacing warfarin and other vitamin K antagonists for a wide range of indications. Advantages of DOAC therapy are fewer food and drug interactions and fixed dosing without routine laboratory monitoring, making DOACs the perfect choice especially for younger patients, in whom the main indication for anticoagulation is prevention and treatment of venous thromboembolism (VTE). Although DOACs are safer and much more convenient than other anticoagulant alternatives, their profile may have drawbacks, especially for younger female patients in whom reproductive issues need special considerations. These may include the issue of heavy menstrual bleeding (HMB) during anticoagulant therapy, the embryotoxicity risk from inadvertent DOAC exposure during pregnancy, and the prevention or planning of pregnancies during DOAC therapy. This review summarizes the most relevant evidence in this increasingly important field of women’s health.

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Progestogen-releasing intrauterine systems for heavy menstrual bleeding

Cited by 43 publications

References 98 publications

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey

An Update on Contraception in Polycystic Ovary Syndrome

Reproductive issues in women on direct oral anticoagulants

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