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This review compares two injectable hormonal contraceptives containing only progestogen, namely depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET‐EN), for the risks and reasons of their discontinuation and for their clinical effects

Injectable hormonal contraceptives remain in extensive use in many developing countries. There are two progestogen‐only injectable contraceptives that have been available in many countries since the 1980's. These are depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET‐EN). They are both highly effective contraceptives that receive wide acceptance amongst women in their fertile years, and form a sizeable proportion of the health expenditure on contraception. They differ in frequency of administration and cost, and a systematic comparison aids to ensure their rational use. This review seeks to compare DPMA given at a dose of 150 mg IM every 3 months and NET‐EN given at a dose of 200mg IM every 2 months, and determine whether there are differences in contraceptive effectiveness, reversibility and patterns of discontinuation, and their minor and major clinical effects.

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

Version: 2012

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

Progestogens or progestogen‐releasing intrauterine systems for uterine fibroids

Uterine fibroids are common premenopausal benign uterine tumours. Treatment of uterine fibroids includes surgery, medical treatment, or both. Progestogens can be administered by various routes such as orally and by injection. Depot medroxyprogesterone acetate (DMPA is a synthetic progesterone hormone given by intramuscular injection that may inhibit uterine fibroid growth. The progestogen‐releasing (levonorgestrel) intrauterine system (LNG‐IUS) is a device placed inside the uterus that releases the hormone progesterone and can cause endometrial suppression. In this review, three randomised controlled studies were included. Two randomised controlled studies included 131 women and evaluated the beneficial and harmful effects of the LNG‐IUS compared with hysterectomy or a low dose combined oral contraceptive (COC). However, the results were from only one study that compared 29 women with an LNG‐IUS versus 29 women with COC for treating uterine fibroids. The LNG‐IUS appeared to reduce menstrual blood loss and increase haemoglobin levels in premenopausal women with uterine fibroids. Reduction of fibroid size was not significant. In one study that included 56 women treated with preoperative oral progestogens (lynestrenol) compared with gonadotropin‐releasing hormone (GnRH) agonist, the uterine fibroid size was not different. There was no randomised controlled study of DMPA to treat uterine fibroids. The included studies were of poor quality and had small numbers of participants. Indeed, the authors did not recommend the use of progestogens or progestogen‐releasing intrauterine systems in treating premenopausal women with uterine fibroids. More high quality randomized controlled studies evaluating progestogens or progestogen‐releasing intrauterine systems for treating uterine fibroids that have an adequate sample size are needed.

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

Version: 2013

Immediate start of hormonal birth control

Health care providers often tell women to wait until their next menstrual cycle to begin birth control pills. The main reason is to avoid using birth control during an undetected pregnancy. Another method involves starting the pills right away ('immediate start' or 'quick start'). Another birth control method should be used as back‐up for the first seven days. Unclear issues were whether quick start of hormonal birth control works as well as the usual start and whether women like it. The quick start method might improve women's use of hormonal birth control.

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

Version: 2012

Hormonal contraceptives and bone health in women

Hormonal contraceptives have been related to bone changes in women. Whether such changes lead to more bone fractures later in life is not clear. However, bone health is a major public health concern. Bone density declines with age, and the change increases the risk of fracture. Due to concern about bone health, health care providers may not suggest hormonal contraceptives and women may not want to use them.

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

Version: 2014

Ways to improve use of hormonal birth control

Hormonal types of birth control are used by many women worldwide. The most common hormonal methods are birth control pills and injections. These methods often do not work as well as they could. Women may have problems using the birth control as planned. They may miss taking some pills. Other women may stop using a method due to bleeding changes. This review looked at whether more counseling or reminders helped women use these types of birth control.

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

Version: 2013

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

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

The effect of hormonal treatment on advanced or recurrent endometrial cancer

Endometrial cancer is cancer arising from the lining of the womb. Most women with endometrial cancer are diagnosed when their tumour is still confined to the body of the womb. However, about 10% of women with endometrial cancer are diagnosed when the disease is already at an advanced stage. The latter group of patients tend to have much poorer survival.

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

Version: 2015

Hormonal birth control and fracture risk in observational studies

We included studies that looked at hormonal birth control use and fracture risk. We examined the quality of research methods using a tool for observational studies. With these types of studies, investigators need to control for differences in the study groups. We used the results from adjusted analyses as reported. Where we did not have adjusted analysis, we used the odds ratio to look at differences between groups.

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

Version: 2015

Progestagens and anti‐progestagens for pain associated with endometriosis

Endometriosis is a painful condition where tissue from the lining of the womb (uterus) is found outside the uterus as well. It can cause pain in the abdomen, generally and during periods (menstruation) or sex. Endometriosis can also lead to infertility. Treatments include surgery or drugs to try and shrink the tissue. Progestagens and anti‐progestagens are some of the hormonal drugs used for treatment. This systematic review of trials found limited evidence for the effectiveness of these drugs in the reduction of pain from endometriosis. This was due to the limited number of randomised controlled trials comparing each drug.

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

Version: 2012

Copper IUDs versus long‐acting hormone injections and implants for contraception

Reversible, long‐term contraception is relied on by millions of women to prevent unwanted pregnancy. Two very common methods of pregnancy prevention are the use of a copper‐containing intrauterine device (IUD) or an injection of a progestogen hormone.

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

Version: 2011

Hormone contraceptives for women with sickle cell anemia

Whether women with sickle cell anemia should use hormonal birth control is unknown. Sickle cell anemia is a blood disease. This type of anemia also causes bone pain known as sickle pain crises. A concern is that women with this disease using hormonal birth control may have blood vessels blocked by blood clots or have more bone pain. Clinicians often do not prescribe these types of birth control due to these concerns. However, many women with sickle cell anemia are sexually active, are able to get pregnant and are interested in contraception.

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

Version: 2011

No evidence to support use of adjuvant progestagens to prevent recurrence of endometrial cancer after surgery

Endometrial (womb) cancer is the most common genital tract cancer in developed countries. Progestagen (a hormone) therapy is sometimes used following initial surgery to reduce the risk of recurrence. However, progestagens have been found to reduce one of the protective factors against heart disease and may also make tumours more resistant to radiotherapy. This review found no evidence to support the use of progestagen as an addition to surgery for newly diagnosed endometrial cancer. Progestagen can, however, prevent or delay recurrence of cancer in some patients.

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

Version: 2015

Effects of progestin‐only birth control on weight

Progestin‐only contraceptives (POCs) can be used by women who cannot or should not take the hormone estrogen. Many POCs are long acting, cost less than some other methods, and work well to prevent pregnancy. Some people worry that weight gain is a side effect of these birth control methods. Concern about weight gain can keep women from using these methods. Further, some women may stop using birth control early, which can lead to unplanned pregnancy. We looked at studies of POCs and changes in body weight.

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

Version: 2016

When can a woman have repeat progestogen-only injectables: depot medroxyprogesterone acetate or norethisterone enantate?

This review concluded that following the last injection of depot medroxyprogesterone acetate or norethisterone enantate extremely low pregnancy rates were reported during the two-week interval following the reinjection date. Given the poor reporting of the review process, poor study quality and small samples in the included studies, the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Systematic review of systemic therapy for advanced or recurrent endometrial cancer

OBJECTIVE: To evaluate the chemotherapeutic options for women with advanced or recurrent endometrial cancer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials

BACKGROUND: Hormone replacement therapy (HRT) is widely used to controlling menopausal symptoms and prevent adverse cardiovascular events. However, the benefit and risk of HRT on cardiovascular outcomes remains controversial.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Progestational agents to prevent preterm birth: a meta-analysis of randomized controlled trials

This well-conducted review assessed progestational agents for the prevention of pre-term birth. The authors concluded that progestational agents can reduce the incidence of pre-term birth and low birth weight newborns. No difference was found in hospitalisation for threatened pre-term birth or perinatal mortality. Although the exact quality of the included studies was unknown, the conclusion is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007
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