Cochrane · systematic review · CD008994
Progestogens or progestogen‐releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy)
Sangkomkamhang, US, Lumbiganon, P, Pattanittum, P · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
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
14
current version
GRADE rated
11
No studies
3
Included studies
NR
No studies 3 · 21.4%Ungraded 0 · 0%Very low 11 · 78.6%Low 0 · 0%Moderate 0 · 0%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
Current version onlyLevonorgestrel‐releasing intrauterine device compared to low dose combined oral contraceptive for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine fibroid‐related symptoms (change in abnormal uterine bleeding, measured at 12 months, with the alkaline hematin test) Levonorgestrel‐releasing intrauterine device vs low dose combined oral contraceptive | no estimate extracted | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Uterine fibroid‐related symptoms (change in abnormal uterine bleeding, measured at 12 months, with the pictorial blood assessment chart (PBAC)) Levonorgestrel‐releasing intrauterine device vs low dose combined oral contraceptive | no estimate extracted | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Uterine fibroid‐related symptoms (haemoglobin level, at 12 months; higher = better) Levonorgestrel‐releasing intrauterine device vs low dose combined oral contraceptive | no estimate extracted | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Fibroid size (percentage of change, at 12 months; higher = better) Levonorgestrel‐releasing intrauterine device vs low dose combined oral contraceptive | no estimate extracted | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Levonorgestrel‐releasing intrauterine device vs low dose combined oral contraceptive | no estimate extracted | NR | No studies |
Levonorgestrel‐releasing intrauterine device compared to oral progestogen (norethisterone acetate) for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine fibroid‐related symptoms (change in abnormal uterine bleeding, measured from baseline to 6 months, with a visual bleeding score (VBS); lower = better) Levonorgestrel‐releasing intrauterine device vs oral progestogen (norethisterone acetate) | no estimate extracted | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Uterine fibroid‐related symptoms (change in haemoglobin level, from baseline to 3 months; higher = better) Levonorgestrel‐releasing intrauterine device vs oral progestogen (norethisterone acetate) | no estimate extracted | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Uterine fibroid‐related symptoms (change in haemoglobin level, from baseline to 6 months; higher = better) Levonorgestrel‐releasing intrauterine device vs oral progestogen (norethisterone acetate) | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision |
Fibroid size Levonorgestrel‐releasing intrauterine device vs oral progestogen (norethisterone acetate) | no estimate extracted | NR | No studies |
Adverse events (spotting at 3 and 6 months) Levonorgestrel‐releasing intrauterine device vs oral progestogen (norethisterone acetate) | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision |
Oral progestogen (dienogest, desogestrel) compared to goserelin acetate for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine fibroid‐related symptoms (duration of uterine bleeding, measured at 12 weeks; lower = better) Oral progestogen (dienogest, desogestrel) vs goserelin acetate | no estimate extracted | 1 study · 14 participants | Very low Downgraded: risk of bias, imprecision |
Uterine fibroid‐related symptoms (abnormal uterine bleeding, measured at 12 weeks, with the pictorial blood assessment chart (PBAC); lower = better) Oral progestogen (dienogest, desogestrel) vs goserelin acetate | no estimate extracted | 1 study · 14 participants | Very low Downgraded: risk of bias, imprecision |
Fibroid size Oral progestogen (dienogest, desogestrel) vs goserelin acetate | no estimate extracted | NR | No studies |
Adverse events (vasomotor symptoms (e.g. hot flashes) Oral progestogen (dienogest, desogestrel) vs goserelin acetate | no estimate extracted | 1 study · 14 participants | Very low Downgraded: risk of bias, imprecision |
Levonorgestrel‐releasing intrauterine system (LNG‐IUS) versus low dose combined oral contraceptive (COC) for uterine fibroids
Population: patients with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Menstrual blood loss (MBL) reduction at 12 months ‐ MBL reduction by the alkaline hematin test The alkaline hematin test. Scale from: 0 to 100. Levonorgestrel‐releasing intrauterine system (LNG‐IUS) vs low dose combined oral contraceptive (COC) | no estimate extracted | 1 study · 58 participants | Low Downgraded: imprecision |
Menstrual blood loss (MBL) reduction at 12 months ‐ MBL reduction by a pictorial assessment chart (PBAC) A pictorial assessment chart (PBAC). Scale from: 0 to 100. Levonorgestrel‐releasing intrauterine system (LNG‐IUS) vs low dose combined oral contraceptive (COC) | no estimate extracted | 1 study · 58 participants | Low Downgraded: imprecision |
Reduction in fibroid size at 12 months Ultrasound. Scale from: 0 to 10. Levonorgestrel‐releasing intrauterine system (LNG‐IUS) vs low dose combined oral contraceptive (COC) | no estimate extracted | 1 study · 58 participants | Low Downgraded: imprecision |
Haemoglobin level ‐ Haemoglobin level at 12 months Scale from: 0 to 20. Levonorgestrel‐releasing intrauterine system (LNG‐IUS) vs low dose combined oral contraceptive (COC) | no estimate extracted | 1 study · 58 participants | Low Downgraded: imprecision |
Lynestrenol versus leuprorelin (leuprolide) for uterine fibroids
Population: patients with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean decrease of fibroid size at 16 weeks Ultrasonography. Scale from: 0 to 30. Lynestrenol vs leuprorelin (leuprolide) | no estimate extracted | 1 study · 46 participants | Low |
Haemoglobin level at 16 weeks Lynestrenol vs leuprorelin (leuprolide) | no estimate extracted | 1 study · 45 participants | Low |
Pelvic pain ‐ At 28 days Lynestrenol vs leuprorelin (leuprolide) | RR 1.2 [0.56, 2.56] | 1 study · 55 participants | Low |
Pelvic pain ‐ At 16 weeks Lynestrenol vs leuprorelin (leuprolide) | RR 1.48 [0.59, 3.71] | 1 study · 49 participants | Low |
Other fibroid symptoms (non‐pelvic pain) ‐ At 28 days Lynestrenol vs leuprorelin (leuprolide) | RR 1.32 [0.68, 2.56] | 1 study · 54 participants | Low |
Other fibroid symptoms (non‐pelvic pain) ‐ At 16 weeks Lynestrenol vs leuprorelin (leuprolide) | RR 2.41 [0.9, 6.49] | 1 study · 49 participants | Low |