Combined oral contraceptives for heavy menstrual bleeding

An analysis «Fraser IS, Jensen J, Schaefers M et al. Normalizat...»1 from two identically designed randomized, placebo-controlled, multiple center studies conducted in Europe, Australia and North America assessed the effectiveness of combined oral contraceptive (COC with estradiol valerate plus dienogest) in reducing menstrual blood loss (MBL) in women with objectively confirmed heavy menstrual bleeding. Women aged ≥ 18 years were randomized to COC (n=220) or placebo (n=135) for 7 treatment cycles. At study end, the proportion of women successfully treated (MBL below 80 mL and ≥ 50% reduction in MBL) with COC and placebo were 63.6% and 11.9%, respectively; with 68.2% and 15.6% of women with MBL below 80 mL, and 70.0% and 17.0% with MBL reduction ≥ 50% (all p<.001).

A Cochrane review «Combined hormonal contraceptives for heavy menstrual bleeding»1 «....»2 included 8 trials involving 805 participants. COC improved response to treatment (return to menstrual 'normality') and lowered MBL (table «Combined oral contraceptives for heavy menstrual bleeding...»1) when compared to placebo. Minor adverse events, in particular breast pain, were more common with COC. The Levonorgestrel-releasing intrauterine system was more effective than COC in reducing MBL (OR 0.21, 95% CI 0.09 to 0.48; 2 trials; n=151). The study found no significant difference between groups treated with oral contraceptives, mefenamic acid, low dose danazol or naproxen.