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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

Hormones for contraception (birth control) in men

Researchers have tried to develop contraceptives for men that would be like birth control pills for women. Hormone birth control for men has been hard to achieve. Giving sex hormones to men can lower the sperm produced. However, this approach also lowers the male hormone testosterone in the body, so some testosterone has to be 'added back.' This review looks at the randomized controlled trials of giving hormones to men to prevent their sexual partners from becoming pregnant.

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

Version: 2012

Antifibrinolytic agents help reduce heavy menstrual bleeding in women

Heavy menstrual bleeding (more than 80mls blood loss per menstrual cycle) is a common problem for women and can have a negative effect on their quality of life. In comparison to women with normal menstrual blood loss, these women have more enzymes in the lining of the uterus that dissolve blood clots. Options to avoid surgery include antifibrinolytic therapy (taking drugs to block these enzymes). The review of trials found that tranexamic acid, the most commonly used antifibrinolytic agent helps reduce heavy menstrual bleeding. Problems with flooding, leakage and sex lives are also reduced. No adverse effects were found. More research is needed.

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

Version: 2010

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

Oestrogens and progestins for preventing and treating postpartum depression

Additional research needed to evaluate the effect of oestrogens for the prevention and treatment of postpartum depression but synthetic progesterones should not be administered.

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

Version: 2010

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 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

Use of progesterone or progestogen‐releasing intrauterine systems for heavy menstrual bleeding

Review question: This Cochrane review has evaluated whether the levonorgestrel–releasing intrauterine system (LNG IUS) reduces heavy menstrual bleeding and whether it is safe and acceptable.

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

Version: 2015

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

Use of hormonal contraceptives and HIV acquisition in women: a systematic review of the epidemiological evidence

Whether or not the use of hormonal contraception affects risk of HIV acquisition is an important question for public health. We did a systematic review, searching PubMed and Embase, aiming to explore the possibility of an association between various forms of hormonal contraception and risk of HIV acquisition. We identified 20 relevant prospective studies, eight of which met our minimum quality criteria. Of these eight, all reported findings for progestin-only injectables, and seven also reported findings for oral contraceptive pills. Most of the studies that assessed the use of oral contraceptive pills showed no significant association with HIV acquisition. None of the three studies that assessed the use of injectable norethisterone enanthate showed a significant association with HIV acquisition. Studies that assessed the use of depot-medroxyprogesterone acetate (DMPA) or non-specified injectable contraceptives had heterogeneous methods and mixed results, with some investigators noting a 1·5-2·2 times increased risk of HIV acquisition, and others reporting no association. Thus, some, but not all, observational data raise concern about a potential association between use of DMPA and risk of HIV acquisition. More definitive evidence for the existence and size of any potential effect could inform appropriate counselling and policy responses in countries with varied profiles of HIV risk, maternal mortality, and access to contraceptive services.

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

Version: 2013

Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015
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Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception

Contraception can be divided into two broad categories: hormonal and nonhormonal. There are two categories of hormonal contraception: combined oestrogen and progestogen and progestogen-only. Long-acting reversible contraception (LARC) is defined in this guideline as methods that require administering less than once per cycle or month.

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

Version: October 2005
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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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Oral Progesterone for the Treatment of Menopausal Symptoms: A Review of the Clinical Evidence [Internet]

The purpose of this review is to examine the clinical efficacy of micronized progesterone (Prometrium), a natural, bio-identical hormone, and methoxyprogesterone acetate (MPA; Provera), a synthetic hormone, individually and comparatively, for the management of menopausal symptoms.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 29, 2014
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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

Hormone contraceptives and how the body uses carbohydrates in women without diabetes

Hormone contraceptives may change how the body handles carbohydrates (starches and sugars). Changes may include lower ability to use sugar from food and more problems with the body's insulin. Insulin is a hormone that helps the body use sugar. Problems with blood sugar can increase risk for diabetes and heart disease. These issues have been raised mainly with birth control methods that contain the hormone estrogen.

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

Version: 2014

Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

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

Version: November 12, 2015
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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

Cyclical progestogens for heavy menstrual bleeding

Progestagens may offer some help in reducing heavy menstrual bleeding but are not as effective as other therapies such as danazol and tranexamic acid. Heavy menstrual bleeding (HMB) is when a woman looses 80 ml or more of blood per menstrual cycle (period). Most women with HMB do not show any physical cause so getting help without surgery is an attractive alternative. Progestogens are taken by mouth either during days 15 or 16 to day 26 of the menstrual cycle (short course) or from day 5 to day 26 (long course). The review of trials found that progestogens significantly reduced menstrual blood loss but were less effective than danazol, tranexamic acid and the progesterone‐releasing intrauterine system (IUS).

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

Version: 2009

Systematic Reviews in PubMed

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