Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial.

摘要

It is interesting that the control group in the recent article comparing the levonorgestrel-releasing intrauterine system and short-course oral medroxy-progesterone acetate noted a decrease in menstrual blood loss in subjects with heavy menstrual bleeding. The role of short-course (cycle days 16-25) proges-tin in this population previously has been studied, and is generally thought not to be effective. A Cochrane review noted that there are no placebo-controlled trials examining the effect of short-course progestin, but that in seven studies, short-course progestin was uniformly less effective than all other comparison treatments, including danazol, progestin-releasing intrauterine system, and tranexamic acid. A second meta-analysis summarized four studies comparing patients before and after administration of short-course progestin, and noted no reduction in menstrual blood loss with study-drug administration (-3.6%, 95% (CI) -6.1 to 1.1%).