↓ Skip to main content

Cochrane Database of Systematic Reviews

Treatment of vaginal bleeding irregularities induced by progestin only contraceptives

Overview of attention for article published in this source, October 2013
Altmetric Badge


35 Dimensions

Readers on

117 Mendeley
Treatment of vaginal bleeding irregularities induced by progestin only contraceptives
Published by
John Wiley & Sons, Ltd, October 2013
DOI 10.1002/14651858.cd003449.pub5
Pubmed ID

Abdel-Aleem, Hany, d'Arcangues, Catherine, Vogelsong, Kirsten M, Gaffield, Mary Lyn, Gülmezoglu, A Metin


Despite their high effectiveness, progestin-only contraceptives are considered less than ideal by the many women who experience irregular vaginal bleeding when using them. Current treatments to control these bleeding problems are not sufficiently effective. We evaluated preventive and therapeutic approaches to normalise bleeding irregularities associated with the use of progestin-only contraceptives. Literature was identified through database searches, reference lists, organisations and individuals, covering the period until May-June 2012. Trials with random or systematic allocation, testing interventions for the prevention or treatment of bleeding irregularities associated with the use of progestin-only contraceptives were eligible. Results are expressed as relative risks (RR) with 95% confidence interval (CI) for categorical data and as weighted mean difference (WMD) with 95% CI for continuous data. When we encountered heterogeneity (visual or statistical) we used the random-effects model (quantitative) or did not produce a summary estimate (qualitative). Thirty-three randomised controlled trials enrolling 3677 participants were included. Two thirds of the trials were determined to reflect low to moderate risk of bias.Estrogen treatments reduced the number of days of an ongoing bleeding episode in DMPA and Norplant users. However, treatment frequently led to more discontinuation due to gastrointestinal upset.Combinations of oral ethinyl estradiol and levonorgestrel improved bleeding patterns in Norplant users, but method discontinuation rates were unchanged. One trial reported successful use of combined oral contraceptives in treating amenorrhea among DMPA users.Norplant users, but not Implanon users, administered the anti-progestin mifepristone reported fewer days of bleeding during treatment than those given placebo. Mifepristone used monthly by new Norplant acceptors reduced bleeding, when compared to placebo.A variety of NSAIDS have been evaluated for their ability to treat abnormal bleeding, with mixed results.Norplant users receiving SERM (tamoxifen) had less unacceptable bleeding after treatment and were more likely to continue using Norplant than those receiving placebo.Tranexamic acid, mifepristone combined with an estrogen and doxycycline were more effective than placebo in terminating an episode of bleeding in women using progestin-only contraceptives, according to three small studies. Some women may benefit from the interventions described, particularly with cessation of current bleeding. Several regimens offer promise in regulating bleeding, but findings need to be reproduced in larger trials. The results of this review do not support routine clinical use of any of the regimens included in the trials, particularly for long-term effect.

Mendeley readers

The data shown below were compiled from readership statistics for 117 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 117 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 13 11%
Student > Postgraduate 12 10%
Student > Bachelor 12 10%
Student > Master 11 9%
Student > Ph. D. Student 7 6%
Other 20 17%
Unknown 42 36%
Readers by discipline Count As %
Medicine and Dentistry 45 38%
Nursing and Health Professions 12 10%
Biochemistry, Genetics and Molecular Biology 3 3%
Pharmacology, Toxicology and Pharmaceutical Science 3 3%
Social Sciences 3 3%
Other 7 6%
Unknown 44 38%