Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

Abdel‐Aleem, Hany; d’Arcangues, Catherine; Vogelsong, K; Gülmezoglu, A Metin

doi:10.1002/14651858.cd003449.pub2

Cited by 22 publications

(29 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the second study (32), found that the POP was associated with significant reductions in frequency, duration and intensity of migraine attacks, compared with the COC used with a regular withdrawal period, for women with MO and comorbid rectovaginal endometriosis. Although POPs are typically associated with unpredictable bleeding patterns (35), pooled analysis of adverse effects in our study showed similar risks of adverse effects, including prolonged bleeding, in women with MO on both the POP and the COC.…”

Section: Summary Of Main Resultssupporting

confidence: 60%

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis

et al. 2017

View full text Add to dashboard Cite

Background Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. Data sources and selection MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on >4 non-menopausal women aged 18-50 with migraine diagnosed by formal criteria were included. Data extraction and analysis Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Results Pooled analyses of four studies demonstrated that desogestrel 75 mcg/day, POP significantly but modestly reduced the number of migraine attacks and migraine days. Reduced intensity and duration, reduced analgesic and triptan use were observed, along with improved headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in treatment cessation for <10% of participants. Two studies compared desogestrel POP to a combined oral contraceptive, demonstrating similar migraine outcomes for both treatments. Conclusions The desogestrel POP shows promise in improving migraine in women. Current evidence is observational and based on small samples of women using only one oral progestin-only formulation. Further randomized trials on additional progestin-only contraceptives are required to confirm their role in migraine management. Abstract Background: Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. Objectives: To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. Data sources and selection: MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on >4 non-menopausal women aged 18-50 with migraine diagnosed by formal criteria were included. Data extraction and analysis: Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. R...

show abstract

Section: Summary Of Main Resultssupporting

confidence: 60%

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…37,39 However, progestin-only oral contraceptive pills are infrequently used because they are less forgiving of nonadherence to the dosing schedule and are therefore associated with a higher contraceptive failure rate 40 and because all progestin-only regimens are associated with irregular menstrual bleeding, especially during the first 18 months of use. 41,42 Hence, our finding of similar risks of recurrent VTE for women who did or did not receive hormonal therapy, whether progestin-only or estrogen-containing therapy, supports a treatment selection that incorporates patient preference, including the choice of estrogen-containing contraception. It is important that hormonal therapy is stopped and alternative contraception is considered before discontinuation of anticoagulation, albeit that any increased risk of recurrent VTE with hormonal therapy after stopping anticoagulation is not well defined.…”

Section: Discussionsupporting

confidence: 55%

Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use

Martinelli

Lensing

Middeldorp

et al. 2016

Blood

165

117

View full text Add to dashboard Cite

Key Points• Estrogen-containing or progestin-only hormonal therapy is not associated with increased recurrent VTE risk in women on anticoagulant therapy.• Abnormal uterine bleeding occurred more frequently with rivaroxaban than with enoxaparin/VKAs.Women receiving vitamin K antagonists (VKAs) require adequate contraception because of the potential for fetal complications. It is unknown whether the use of hormonal therapy, especially those containing estrogens, is associated with recurrent venous thromboembolism (VTE) during anticoagulation. Despite the absence of data, World Health Organization guidelines state that use of estrogen-containing contraceptives confers an "unacceptable health risk" during established anticoagulation for VTE. We compared the incidences of recurrent VTE and abnormal uterine bleeding with and without concomitant hormonal therapy in women aged <60 years who were receiving anticoagulation with rivaroxaban or enoxaparin/ VKA for confirmed VTE. Incidence densities in percentage per year were computed for the on and off estrogen-containing or progestin-only therapy periods. Cox regression models were fitted, with hormonal therapy (on vs off) as a time-dependent variable to derive the hazard ratio (HR) for the effects on recurrent VTE and abnormal uterine bleeding. In total, 1888 women were included. VTE incidence densities on and off hormonal therapy were 3.7%/year and 4.7%/year (adjusted HR, 0.56; 95% confidence interval [CI], 0.23-1.39), respectively, and were 3.7%/year and 3.8%/year, respectively, for estrogen-containing and progestin-only therapy. The adjusted HR for all abnormal uterine bleeding (on vs off hormonal therapy) was 1.02 (95% CI, 0.66-1.57). Abnormal uterine bleeding occurred more frequently with rivaroxaban than with enoxaparin/ VKA (HR, 2.13; 95% CI, 1.57-2.89). Hormonal therapy was not associated with an increased risk of recurrent VTE in women receiving therapeutic anticoagulation. The observed increased risk of abnormal uterine bleeding with rivaroxaban needs further exploration. (Blood.

show abstract

“…One trial 14 in a Cochrane review 16 evaluated the effect of estrogen on bleeding in women using depot medroxyprogesterone acetate (DMPA). This randomized trial included 278 women using DMPA with irregular bleeding who were randomised to receive either EE (50 μg), estrogen sulphate (2.5 mg) or placebo daily for 14 days.…”

Section: 13mentioning

confidence: 99%

“…A Cochrane review 16 included trials using estrogen (oral diethylstilbestrol, oral quinesterol or a 17β estradiol transdermal patch) as a preventative treatment for women starting DMPA. The individual trial results were difficult to interpret within the meta-analysis and discontinuation rates were high.…”

Section: 13mentioning

confidence: 99%

Using phytoestrogens as aprophylaxis against irregular uterine bleeding possibly occurring while using Depot-medroxyprogesterone acetate (DMPA) as a contraceptive method

Fattah

2014

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

Cited by 22 publications

References 36 publications

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis

Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis

Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use

Using phytoestrogens as aprophylaxis against irregular uterine bleeding possibly occurring while using Depot-medroxyprogesterone acetate (DMPA) as a contraceptive method

Contact Info

Product

Resources

About