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Differences in effectiveness and adverse effects between different types of progestogens combined with ethinyl oestradiol (combined contraceptive pill)

Combined oral contraceptives (COC) have an oestrogen and a progestogen component. The type of progestogen and/or amount of oestrogen or progestogen can vary per pack of oral contraceptive pills. The objective of this review was to compare currently available low‐dose COCs containing different progestogens in terms of pregnancy prevention, bleeding pattern, side effects and discontinuation rates.

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

Version: 2011

Oestrogens for treatment or prevention of pelvic organ prolapse in women

Many women suffer from pelvic organ prolapse, which is a downward descent of the vagina (front passage) and/or uterus (womb). It is more common after childbirth and after the menopause.  Women may not have symptoms or they may feel bulge and/or pressure vaginally, as well as a range of urinary, bowel and sexual problems. These symptoms may affect quality of life. Prolapse is associated with weakness in muscles and supporting structures in the pelvis. Treatment can be conservative (pessaries or rings), pelvic floor muscle training or surgery.  Oestrogen (female hormone) treatment can be used to reduce thinning of the vaginal and pelvic tissues. This may help to reduce or prevent the symptoms of prolapse, or may be used to make other prolapse treatments work better. This review did not find any clear evidence to suggest whether oestrogens work. However, as they are often used, especially with pessaries or before and after prolapse surgery, research is needed to identify any benefits or risks.  

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

Version: 2010

Hormone therapy for women with endometriosis and surgical menopause

Endometriosis is known to result in variable severity of symptoms. For some women bilateral removal of the ovaries (oophorectomy) with or without an hysterectomy may be required to manage symptoms. This brings women into premature menopause. It is thought that hormone replacement therapy may enhance the recurrence of the disease due to its effect on the remaining endometriotic deposits in the pelvis. Only two small randomised controlled were identified in the literature that looked at this problem. Further research is required to clarify the effect of different hormone replacement therapy types on the recurrence of the disease and the associated pain including during sex.

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

Version: 2010

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

Contraceptive pills and venous thrombosis

Contraceptive pills are among the most popular contraception methods worldwide. A combined oral contraceptive pill contains two components, the estrogen and the progestagen compound. Despite its reliable contraception action, these pills may present side‐effects including obstruction of leg and pulmonary vessels by clots (venous thrombosis). This side‐effect is rare but the most frequently occurring serious adverse effect. Different combination pills show different vessel clotting obstruction tendencies (venous thrombosis risk). Evaluation of these different tendencies may play an important role in choosing the safest pill when starting pill use. COC containing higher estrogen doses (>30 μg) with levonorgestrel (a progestagen) or containing cyproterone acetate or drospirenone as progestagen are associated with higher VT risk than the oral contraceptive pill with 30 μg estrogen and levonorgestrel as progestagen. All combined monophasic oral contraceptive pills have the same effectiveness, that is preventing unwanted pregnancies. 

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

Version: 2014

Birth control pills with three phases versus one phase

Side effects of birth control pills may keep women from using them as planned. Attempts to decrease side effects led to the three‐phase pill in the 1980s. Pills with three phases provide different amounts of hormones over three weeks. One‐phase pills have the same amount of hormone for three weeks. Whether three‐phase pills lead to more pregnancies is unknown. Nor is it known if the pills give better cycle control or fewer side effects. This review looked at whether three‐phase pills worked as well as one‐phase pills. It also studied whether women had fewer side effects with these pills.

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

Version: 2012

Birth control pills with drospirenone for treating premenstrual syndrome

Premenstrual syndrome (PMS) is a common problem. A severe form is called premenstrual dysphoric disorder (PMDD). Birth control pills with the hormones progestin and estrogen have been studied for treating such symptoms. A birth control pill with the progestin drospirenone may work better than other such pills. A drospirenone pill with low estrogen was approved for treating PMDD, the severe form of PMS, in women who use birth control pills.

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

Version: 2012

Chinese herbal medicines for subfertile women with polycystic ovarian syndrome

We reviewed the evidence about the effect of Chinese herbal medicines (CHM) on rates of live birth pregnancy and adverse events in subfertile women with polycystic ovarian syndrome (PCOS).

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

Version: 2016

Use by postmenopausal women of creams, pessaries or a vaginal ring to apply oestrogen vaginally for symptoms of vaginal dryness

Cochrane researchers reviewed the evidence about the efficacy and safety of intravaginal oestrogenic preparations compared with each other or placebo (inactive or sham treatment) in women undergoing treatment for the symptoms of vaginal atrophy.

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

Version: 2016

Fulvestrant in the treatment of postmenopausal women with advanced hormone‐sensitive breast cancer

We reviewed the evidence concerning the effectiveness and safety of fulvestrant in prolonging time without further progression of cancer in women with advanced hormone‐sensitive breast cancer. We found nine studies testing whether or not fulvestrant is superior to other treatment options.

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

Version: 2017

Cyproterone acetate appears to be as effective as other medications for hirsutism in women caused by excessive androgen production by the ovaries

One of the causes of hirsutism (excessive hair growth) in women is excessive production of the hormone androgens by the ovaries. A variety of medications can be used to counter the effects of the androgen. Cyproterone acetate is an anti‐androgen drug. Adverse effects that have been reported with its use include weight gain, depression, fatigue, breast symptoms and sexual dysfunction. The review of trials found that cyproterone acetate appears to have a similar impact on hirsutism as other drugs used for hirsutism caused by excessive androgen. There was not enough evidence to compare adverse effects of the treatment options.

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

Version: 2009

Birth control pills with 20 µg estrogen versus more than 20 µg estrogen

Concerns about safety have led to making birth control pills with less of the hormone estrogen. Pills with less estrogen might not work as well to prevent pregnancy and could cause bleeding problems. This review looked at studies that compared pills with 20 µg ethinyl estradiol versus pills that have more estrogen.

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

Version: 2013

Injectable birth control with both progestin and estrogen

Birth control methods that can be injected may contain two hormones, a progestin and an estrogen. These combined injectable contraceptives (CICs) are effective in preventing pregnancy and can be stopped when a woman wants to get pregnant. This review looked at CICs for how well they prevented pregnancy and for the bleeding patterns and other side effects that may occur. We also studied whether women stopped using them early and whether women liked them.

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

Version: 2013

Birth control pills with two phases versus one phase

Side effects of birth control pills may keep women from using them as planned. Attempts to decrease side effects led to the two‐phase pill. Pills with phases provide different amounts of hormones over three weeks. Whether two‐phase pills lead to fewer pregnancies than one‐phase pills is unknown. Nor is it known if the pills give better cycle control or have fewer side effects. This review looked at whether two‐phase pills worked as well as one‐phase pills. It also studied whether women had fewer side effects with these pills.

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

Version: 2011

Birth control pills with two phases versus three phases

Side effects of birth control pills may keep women from using them as planned. Attempts to decrease side effects led to the three‐phase pill in the 1980s. Pills with phases provide different amounts of hormones over three weeks. Whether three‐phase pills lead to fewer pregnancies than two‐phase pills is unknown. Nor is it known if the pills give better cycle control or have fewer side effects. This review looked at whether two‐phase pills worked as well as three‐phase pills. We also studied whether women had fewer side effects with these pills.

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

Version: 2011

Hormone replacement therapy for women with type 1 diabetes mellitus

There are increasing numbers of people living with type 1 diabetes mellitus. The main aim of treatment for diabetes is to maintain good quality of life and to minimise, or prevent, the development of diabetic complications by controlling blood glucose levels. Women with type 1 diabetes frequently express difficulties in controlling their blood glucose levels during the menopausal phase of their lives. However, the cause of this has not been explored.

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

Version: 2013

Monitoring of stimulated cycles in fertility treatment involving in vitro fertilisation (IVF) and intra‐cytoplasmic sperm injection (ICSI)

Review question: can ultrasound alone be used safely without adding estradiol blood test measurements to monitor women undergoing controlled ovarian hyperstimulation during IVF and ICSI? We reviewed the evidence on monitoring women undergoing controlled ovarian hyperstimulation as part of IVF or ICSI by transvaginal ultrasound (TVUS) only versus traditional combined monitoring (TVUS) and blood hormone (estradiol) levels.

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

Version: 2014

Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction

Researchers in the Cochrane collaboration reviewed the evidence about the effectiveness and safety of androgens in women undergoing assisted reproduction. The androgens evaluated were dehydroepiandrosterone (DHEA) and testosterone (T) as pre‐ or co‐treatments aiming to improve pregnancy and live birth rates in those women.

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

Version: 2015

Bioidentical hormones for vasomotor menopausal symptoms (hot flushes or night sweats)

This Cochrane review evaluates the effectiveness and safety of bioidentical hormone treatment (BHT) compared to no treatment or non‐bioidentical hormone treatment (HT) for vasomotor symptoms experienced during the menopausal transition period.

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

Version: 2016

Treatments for unwanted male pattern hair growth in women

Up to 5% to 10% of women are hirsute (hair in areas where normally only men have hairs such as moustache, beard area, chest, belly, back etc). The most common cause is polycystic ovary syndrome. Hirsutism can lead to psychological distress, low self esteem, decreased self image, depression, feelings of shame and social difficulties.

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

Version: 2017

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