Cochrane · systematic review · CD000154
Combined hormonal contraceptives for heavy menstrual bleeding
Lethaby, A, Wise, MR, Weterings, MAJ, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Gynaecology and FertilityAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
21
current version
GRADE rated
14
No studies
7
Included studies
NR
No studies 7 · 33.3%Ungraded 0 · 0%Very low 9 · 42.9%Low 2 · 9.5%Moderate 3 · 14.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Combined oral contraceptive pill compared to placebo for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response to treatment Combined oral contraceptive pill vs placebo | OR 22.12 [4.4, 111.12] | 2 studies · 363 participants | Moderate |
Improvement in MBL (participant assessment) Combined oral contraceptive pill vs placebo | OR 5.15 [3.16, 8.4] | 2 studies · 339 participants | Moderate |
Other primary menstrual bleeding and satisfaction outcomes: semi‐objectively assessed menstrual blood loss, participant satisfaction with treatment Combined oral contraceptive pill vs placebo | no estimate extracted | NR | No studies |
Adverse events ‐ Any adverse events (treatment‐emergent) Combined oral contraceptive pill vs placebo | OR 2.17 [1.34, 3.5] | 2 studies · 411 participants | Moderate |
Combined oral contraceptive pill compared to non‐steroidal anti‐inflammatory drugs for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Menstrual blood loss (end of trial values) Combined oral contraceptive pill vs non‐steroidal anti‐inflammatory drugs | no estimate extracted | 1 study · 32 participants | Very low |
Other primary menstrual bleeding and satisfaction outcomes: semi‐objectively assessed menstrual blood loss, subjectively assessed menstrual blood loss, participant satisfaction with treatment Combined oral contraceptive pill vs non‐steroidal anti‐inflammatory drugs | no estimate extracted | NR | No studies |
Adverse events Combined oral contraceptive pill vs non‐steroidal anti‐inflammatory drugs | no estimate extracted | NR | No studies |
Combined oral contraceptive pill compared to levonorgestrel‐releasing intrauterine system for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment success (PBAC < 100 at end of treatment or no requirement for alternative treatment ) Combined oral contraceptive pill vs levonorgestrel‐releasing intrauterine system | OR 0.21 [0.09, 0.48] | 2 studies · 151 participants | Low |
Satisfaction with treatment Combined oral contraceptive pill vs levonorgestrel‐releasing intrauterine system | OR 0.29 [0.06, 1.4] | 1 study · 37 participants | Very low |
Other primary menstrual bleeding outcomes: semi‐objectively assessed menstrual blood loss, subjectively assessed menstrual blood loss Combined oral contraceptive pill vs levonorgestrel‐releasing intrauterine system | no estimate extracted | NR | No studies |
Adverse effects ‐ Any adverse events Combined oral contraceptive pill vs levonorgestrel‐releasing intrauterine system | OR 1.5 [0.22, 10.14] | 1 study · 39 participants | Very low |
Combined oral contraceptive pill compared to contraceptive vaginal ring for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response to treatment Combined oral contraceptive pill vs contraceptive vaginal ring | OR 0.37 [0.12, 1.17] | 1 study · 50 participants | Very low |
Menstrual blood loss ‐ At end of treatment (MBL) Combined oral contraceptive pill vs contraceptive vaginal ring | no estimate extracted | 2 studies · 100 participants | Very low |
Menstrual blood loss ‐ After 3 months Combined oral contraceptive pill vs contraceptive vaginal ring | no estimate extracted | 1 study · 50 participants | Very low |
Satisfaction with treatment Combined oral contraceptive pill vs contraceptive vaginal ring | OR 0.38 [0.11, 1.33] | 1 study · 50 participants | Very low |
Other primary menstrual bleeding outcomes: objectively assessed menstrual blood loss, subjectively assessed menstrual blood loss Combined oral contraceptive pill vs contraceptive vaginal ring | no estimate extracted | NR | No studies |
Adverse events: nausea Combined oral contraceptive pill vs contraceptive vaginal ring | OR 5.56 [1.27, 24.39] | 2 studies · 100 participants | Low |
Contraceptive vaginal ring compared to progestogens for heavy menstrual bleeding
Population: heavy menstrual bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Menstrual blood loss (at end of study) Contraceptive vaginal ring vs progestogens | no estimate extracted | 1 study · 95 participants | Very low Downgraded: risk of bias |
Other primary menstrual bleeding outcomes: objectively assessed menstrual blood loss, subjectively assessed menstrual blood loss Contraceptive vaginal ring vs progestogens | no estimate extracted | NR | No studies |
Satisfaction Contraceptive vaginal ring vs progestogens | OR 3.28 [1.4, 7.67] | 1 study · 95 participants | Very low Downgraded: risk of bias |
Adverse events Contraceptive vaginal ring vs progestogens | no estimate extracted | NR | No studies |