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Table 8.3Combined oral contraceptives for treatment of HMB – comparative studies

Bibliographic informationStudy type and evidence levelNo. of patientsPatient characteristicsIntervention and comparisonFollow-upOutcome measuresEffect sizeSource of funding and additional comments
Coulter 1995273Systematic review; meta-analysis

EL = 1+
Population characteristics: Searches undertaken on MEDLINE

Country:
Review of evidence for treatment of HMBMBLAntifibrinolytics: Pooled result from 7 trials was a % reduction in MBL of 46.7 (95% CI 47.9–51.6).

Reports on 4 RCT of etamsylate. Meta-analysis identifies a % blood loss reduction of 13.1 (95% CI 10.9–15.3).

Norethisterone: 4 RCTs showed a reduction change in MBL of −3.6% (−6.1, 1.1)

Danazol: 5 RCTs showed a combined reduction in MBL of 49.7% (47.9, 51.6)

IUDs: 4 RCTS showed a combined reduction in MBL of 58.6 (56.7, 60.6)

Mefenamic acid: Pooled results for 10 studies = −29% (95% CI 27.9–30.2). Diclofenac: 2 studies = −26.9% (23.3–30.6). Naproxen: 5 studies = – 26.4% (24.6–28.3). Ibuprofen: 3 studies = −16.2% (13.6–18.7). OCP: 1 RCTMBL reduction = 43%

Side effects not reported.
Funding source: Not stated

Study summary: Studies of this preparation report greater reductions in blood loss but slightly more side effects than mefenamic acid.
Fraser 1991274randomised

EL = 1+
45 in total. 7 dropped out. 38 assessed: 19 in mefenamic (across 3 groups); 7 naproxen; 6 OCP; 6 danazolPopulation characteristics: Women; menorrhagia – ovulatory DUB; no pathology; no hormonal therapy within 3 months

Country: Australia
Mefenamic acid (500 mg × 3); naproxen; low dose monophasic oral contraceptive – ethinyl estradiol 30 μg and levonorhestrel 150 μg for 21 days; danazol (200 mg) daily

Treatment vs baseline
8 consecutive cycles: 2 no treatment; 2 treatment; 2 no treatment; 2 treatmentMBL – alkaline haematinMefenamic acid – group 1 – control = 131.1 ml (SD 80.8) treatment = 105.1 (SD 88.6) (P = 0.198) (−20%);

group 2 – control = 101 (SD 52.5), treatment = 62.9 (SD 27.7) (P = 0.002) (−38%);

group 3 – control = 90.3 (50.2), treatment = 55.3 (34) (P < 0.001) (−39%);

Naproxen – control = 131.1 ml vs treatment = 115.6 (SD 113) ml (P = 0.079) (−12%);

Oral contraceptive – 101 vs 57.8, P < 0.001, −43%;

Danazol – 90.3 vs 45.5 (av), P < 0.001, −49%.

Differences between Mefanamic vs naproxen P = 0.129; vs oral contraceptive P = 0.154; vs danazol P = 0.079.

Side effects not reported.
Funding source: Commercial funding

Study summary: All treatments reduce MBL.
Iyer 2000272Systematic review

EL = 1++
1 study included in reviewPopulation characteristics: Search strategy based on key words and MeSH headings

Search on MEDLINE, EMBASE, Cochrane library, CINAHL, PsycINFO.

Hand searching of 20 journal and conferences proceedings
RCT – Oral Contraceptive pillMBL; side effects; QoLOne study included in review (17 rejected). OCP vs Naproxen (n = 12) – MBL = 66.77 vs 58.4, difference = 8.37 [95% CI −27.31, 44.05](−12.5%). OCP vs danazol (n = 12) – MBL = 66.77 vs 47.5, difference = 19.27 [−24.47, 63.01] (−29%). OCP vs mefenamic acid (n = 12) – MBL = 66.77 vs 84.26, difference = −17.49 [−62.77, 27.79]. (+26%).

Side effects and QoL not reported.
Funding source: No funding

From: Evidence Tables

Cover of Heavy Menstrual Bleeding
Heavy Menstrual Bleeding.
NICE Clinical Guidelines, No. 44.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Jan.
Copyright © 2007, National Collaborating Centre for Women's and Children's Health.

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