Home > Search Results

Results: 1 to 20 of 138

Evaluation of treatments for vaginal bleeding induced by progestin‐only contraceptives

As the use of progestin‐only methods of contraception continues to increase worldwide, the problem of vaginal bleeding disturbances these methods induce is becoming of increasing public health relevance.Since this adverse effect limits method's acceptability, and leads to loss of compliance. Some women may benefit to some degree from some interventions tested. However the evidence reviewed is not strong enough to recommend routine use of any of the regimens included in the trials, particularly for long‐term effects. Positive results need to be reproduced in larger scale trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Do vaginal packing, tranexamic acid, interventional radiology or other interventions control vaginal bleeding in women with advanced cervical cancer?

Background: Cervical cancer (cancer of the neck of the womb) is the second most common cancer among women throughout the world, accounting for about 500,000 new detected cases and 273,000 deaths every year. Women more commonly present with advanced disease in the developing world, where access to cervical screening programmes is limited. Advanced cancer of the cervix may not be curable and women often need treatment to control distressing symptoms (palliation), such as vaginal bleeding. Bleeding can be severe enough to be life threatening in women with advanced cervical cancer. Management of vaginal bleeding often poses a challenge, especially in the developing world, where access to radiotherapy is limited. Options for palliative treatment of severe vaginal bleeding include interventional radiology treatment (using x‐rays to guide the insertion of 'plugs' into blood vessels supplying the cancer) or vaginal packing (where gauze is compacted into the vagina to absorb the blood and apply pressure directly to the cervix), although these are often only partly effective and may cause harm. Vaginal packs can be soaked with formalin, which is a preservative chemical. Other options for treating severe vaginal bleeding include tranexamic acid (a medicine that reduces bleeding that can be given by mouth or by injection) and radiotherapy (high‐energy x‐ray treatment).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Uterine massage for preventing postpartum haemorrhage

Bleeding after childbirth (postpartum haemorrhage) is the leading cause of maternal deaths in Sub‐Saharan Africa and Egypt, and yet it is largely preventable. Possible causes of heavy bleeding directly following childbirth or within the first 24 hours are that the uterus fails to contract after delivery (uterine atony), a retained placenta, inverted or ruptured uterus, and cervical, vaginal, or perineal tears.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Position in the second stage of labour for women without epidural anaesthesia

Women should be encouraged to give birth in comfortable positions, which are usually upright.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Combined hormone therapy is more effective than tibolone on menopausal symptoms. Tibolone may increase the risk of recurrent breast cancer and stroke

The authors analysed 33 clinical trials to evaluate whether tibolone, compared to placebo or combined hormone replacement therapy (HT), was effective in alleviating menopausal symptoms and the risks associated with the longer term use of HT. Limited evidence suggested that tibolone was less effective than combined HT in the treatment of menopausal symptoms, although fewer women suffered vaginal bleeding. In two separate trials, prolonged use of tibolone (for one or more years) increased the risk of breast cancer in women who had already suffered from breast cancer in the past and increased the risk of stroke in women whose mean age was over 60 years. The risk profile of this drug is not well defined but it is concerning enough that its longer term use should not be supported.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Hormone therapy for postmenopausal women with intact uterus

Hormone therapy may be used to manage troublesome menopausal symptoms, but is currently recommended to be given at the lowest effective dose and regularly reviewed by a woman and her doctor. In women with an intact uterus hormone therapy comprising estrogen and progestogen is desirable to minimise the risk of endometrial hyperplasia, which can develop into endometrial cancer. Low‐dose estrogen plus progestogen (minimum of 1 mg norethisterone acetate or 1.5 mg medroxyprogesterone acetate) taken daily (continuously) appears to be safe for the endometrium. For women who had their last menstrual period less than one year ago low‐dose estrogen combined sequentially with 10 days of progestogen (1 mg norethisterone acetate) per month appears to be safe for the endometrium.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Progestin‐only pills for contraception

Progestin‐only pills, as their name implies, contain just one hormone. The more common birth control pills combine two hormones. How these one‐hormone pills compare to each other or to two‐hormone pills is not clear. Hence, we did this review to compare progestin‐only pills to other similar pills or to combined (two‐hormone) pills. Through October 2013, we did a computer search and literature search to find randomized trials of progestin‐only pills.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Birth control pills with three phases versus one phase

Standard birth control pills contain two hormones: progestogen and estrogen. One‐phase birth control pills contain the same dose of progestogen and estrogen every day. Four‐phase birth control pills contain different amounts of progestogen and estrogen on different days. This review looked at how well one‐phase birth control pills and four‐phase birth control pills work to prevent pregnancy, how often they cause bleeding problems, how often users experience side effects and how many women stop using the pills.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Carbetocin for preventing postpartum haemorrhage

In low‐ and middle‐income countries, postpartum haemorrhage is a major cause of maternal deaths and ill health. In high‐income countries, the problems are much less but there is still a small risk of major bleeding problems for women after giving birth. Active management of the third stage of labour, which is generally used to reduce blood loss at birth, consists of giving the mother a drug that helps the uterus to contract, early cord clamping and controlled cord traction to deliver the placenta. Different drugs have been tried and generally either intramuscular oxytocin or intramuscular syntometrine is given. Carbetocin is an oxytocin agonist. Oxytocin agonists are a group of drugs that mimic the oxytocin action, oxytocin being the natural hormone that helps to reduce blood loss at birth. This review includes 11 randomised controlled trials involving 2635 women. The trials compared carbetocin against either oxytocin or syntometrine given after delivery, vaginally or by caesarean section. The comparison between intramuscular carbetocin and oxytocin showed that there was no difference in the risk of heavy bleeding, but that women who received carbetocin were less likely to require other medications to produce uterine contractions following caesarean sections. Comparisons between carbetocin and syntometrine showed that women who received carbetocin had less blood loss compared to women who received syntometrine after vaginal delivery, and were much less likely to experience side effects such as nausea and vomiting. The incidence of hypertension at 30 and 60 minutes post delivery was also significantly lower in women who received carbetocin compared to those who received syntometrine. Five of the 11 studies were known to be supported by a pharmaceutical company.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Tranexamic acid for preventing bleeding after delivery

Postpartum haemorrhage is a common and an occasionally life‐threatening complication of labour. The majority of women receive drugs that directly stimulate the uterus (prophylactic uterotonics) during childbirth to prevent haemorrhages resulting from failure of the uterine muscle to contract normally (uterine atony).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions to reduce haemorrhage during myomectomy for treating fibroids

Some women have non‐cancerous growths of the uterus, called fibroids. In a third of cases the fibroids produce symptoms, such as vaginal bleeding, that warrant treatment. The surgical removal of the fibroids, called myomectomy, is one of the treatment options for fibroids. It can be accomplished by either laparotomy (through an incision into the abdomen) or laparoscopy (keyhole surgery). The procedure is associated with heavy bleeding. Many interventions have been used by doctors to reduce bleeding during an operation for removing fibroids but it is unclear whether or not the interventions are effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth

We did not identify any trials to say if women with retained placenta after giving birth would benefit from routine antibiotics prior to manual removal of placenta.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Administration of uterotonic drugs before and after placental delivery as part of the management of the third stage of labour following vaginal birth

Active management of the third stage of labour has been shown to reduce the risk of postpartum haemorrhage. It usually involves clamping and cutting the cord, administration of uterotonic drugs and controlled cord traction (inserting pressure on the uterus and pulling the cord mainly with the sign of placental separation). Although active management has been shown to reduce the risk of postpartum haemorrhage, it may have an impact on the well‐being of the mother and baby in terms of the amount of blood that has been transfused to the baby before the separation of the placenta. The optimum timing of uterotonic administration (before or after placental expulsion) can have a major role in this process and it has not been systematically investigated previously. This review of three trials (1671 participants) found that routine administration of oxytocin with the anterior shoulder compared with use of oxytocin after delivery of the placenta did not have any influence on the amount of bleeding postpartum or retained placenta. The route of administration of oxytocin in two of the three included studies was through intravenous infusion. Cord management at delivery was consistent with double clamping and immediate cutting after delivery of the baby. Application of controlled cord traction was slightly different among the included studies. In two of the studies, the placenta was delivered with controlled cord traction when signs of placental separation were present. Fundal pressure on the uterus was used in one study from the beginning to ensure continued uterine contraction. Oxytocin was the only uterotonic assessed. There were no assessments of any impact on neonatal health. More well designed studies using consistent approaches in this area of the management of the third stage of labour are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period

Haemorrhage following childbirth (postpartum haemorrhage) is a major cause of maternal death and health problems in resource‐poor settings in both low‐ and high‐income countries. Postpartum haemorrhage is defined as blood loss from the genital tract of more than 500 mL, generally occurring within the first 24 hours after delivering the placenta and occasionally between 24 hours and six to 12 weeks. Possible causes are the uterus (womb) failing to contract after delivery (uterine atony), a retained placenta, inverted or ruptured uterus, and cervical, vaginal, or perineal lacerations. To address these issues, the joint policy statements between the International Confederation of Midwives, the International Federation of Gynecology and Obstetrics, and the World Health Organization recommend 'active management of third stage of labour', which includes the administration of a uterotonic drug (intravenous oxytocin), just before or just after delivery in order to help the uterine muscles to contract. The use of oral uterotonic drugs such as methylergometrine for the prevention of postpartum haemorrhage after delivery of the placenta is not recommended in the joint policy statements. Yet orally delivered uterotonic drugs, such as ergot alkaloids (including methylergometrine), herbal therapies, or homeopathic remedies are easy‐to‐administer agents that may be considered as possible alternatives after delivery of the placenta in developing countries, as in Japan. We set out to determine whether such agents are effective in preventing haemorrhage after childbirth. We found a total of five randomised clinical trials (involving 1466 women). In three of the trials (involving 1268 women), oral methylergometrine was compared with placebo (two trials) or the Japanese traditional herbal medicine Kyuki‐chouketsu‐in (one trial). The other two trials (involving 198 women) did not report information on relevant outcomes of interest for this review. Overall, there was no clear evidence that prophylactic oral methylergometrine was effective in reducing haemorrhage after childbirth. The trials were not of good quality and adverse events were not well‐reported. We did not find any completed trials looking at the effectiveness of homeopathic remedies in reducing haemorrhage after childbirth. The effectiveness of such remedies warrants further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pre‐operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding

Cochrane authors reviewed evidence for the effectiveness and safety of medications used to thin the lining of the womb before surgery performed to destroy (ablate) this lining (endometrium) in premenopausal women with heavy menstrual bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Uterine muscle relaxant drugs for threatened miscarriage

Not enough evidence to say if drugs that relax the muscles of the uterus can prevent threatened miscarriage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Effectiveness of Copper‐containing intra‐uterine devices (coil)

T‐shaped IUDs with copper on the arms are the most effective, have the longest duration of action and are the IUDs of choice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Using creams, pessaries or a vaginal ring to apply oestrogen vaginally relieves the symptoms of vaginal atrophy, although some creams may cause adverse effects.

Vaginal atrophy is a common condition in women after menopause. It causes vaginal dryness and itching and can make intercourse painful. The female hormone oestrogen is a treatment option for vaginal atrophy, but can cause adverse effects such as bleeding and breast tenderness. Women can take oestrogen through tablets or injections. Alternatively, they can apply the hormone locally using creams, pessaries (tablets placed in the vagina) or a hormone‐releasing ring placed in the vagina. The review found that all methods of delivering oestrogen relieved the symptoms. However, some creams may cause adverse effects and women preferred vaginal rings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Extra‐abdominal versus intra‐abdominal repair of the uterine incision at caesarean section

There is not enough evidence to say if closing the cut in the womb after caesarean section is better done within the abdomen or outside.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Aromatase inhibitors for women with uterine fibroids

Uterine fibroids are the most common benign tumours in women of reproductive age. By causing heavy or irregular bleeding, subfertility or pelvic pressure symptoms, uterine fibroids have a major impact on women's health and on their quality of life. Traditional surgical treatments have a high recurrence rate and high risk of postoperative complications (e.g. pain, infertility); therefore, safer and more effective medical therapy has been sought. It has been suggested that aromatase inhibitors may shrink uterine fibroids by blocking the production of oestrogen. A review of the evidence was conducted by researchers in The Cochrane Collaboration, who searched in August 2013 for all relevant randomised controlled trials and found only one eligible study.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...