Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

Cochrane Review by Abdel-Aleem H, d'Arcangues C, Vogelsong KM, Gülmezoglu AM

This record should be cited as: Abdel-Aleem H, d'Arcangues C, Vogelsong KM, Gülmezoglu AM. Treatment of vaginal bleeding irregularities induced by progestin only contraceptives. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003449. DOI: 10.1002/14651858.CD003449.pub3.

ABSTRACT

Title

Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

Background

Despite their high effectiveness, progestin-only contraceptives are considered less than ideal by the many women who experience irregular vaginal bleeding when using them. Current treatments to control these bleeding problems are not sufficiently effective.

Objectives

We evaluated preventive and therapeutic approaches to normalise bleeding irregularities associated with the use of progestin-only contraceptives.

Search strategy

Literature was identified through database searches, reference lists, organisations and individuals, covering the period until December 2006.

Selection criteria

Trials with random or alternate allocation, testing interventions for the prevention or treatment of bleeding irregularities associated with the use of progestin-only contraceptives were eligible.

Data collection and analysis

Results are expressed as relative risks (RR) with 95% confidence interval (CI) for categorical data and as weighted mean difference (WMD) with 95% CI for continuous data. When we encountered heterogeneity (visual or statistical) we used the random-effects model (quantitative) or did not produce a summary estimate (qualitative).

Main results

Twenty three randomised controlled trials enrolling 2674 participants were included. Seventy per cent were determined to reflect low to moderate risk of bias.

Authors' conclusions

Some women may benefit from the interventions described, particularly with cessation of current bleeding. Several regimens offer promise in regulating bleeding, but findings need to be reproduced in larger trials. The results of this review do not support routine clinical use of any of the regimens included in the trials, particularly for long-term effect.

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