Use of combined oral contraceptives for the management of heavy menstrual bleeding

Evaluation of: Jensen JT, Parke S, Mellinger U, Machlitt A, Fraser I. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet. Gynecol. 117(4), 777–787 (2011).Heavy menstrual bleeding (HMB) is one of the most common reasons for women to seek gynecological care. Surgical and medical treatments have been proposed, including hysterectomy, endometrial ablation, oral progestins, the levonorgestrel-releasing intrauterine system, mefenamic acid and combined oral contraceptives (COCs). Although COCs have been used extensively to control HMB, there is little evidence of their efficacy. A new COC containing estradiol valerate and dienogest was compared with placebo in a randomized clinical trial that included women with objectively confirmed HMB in whom blood loss was measured using the alkaline hematin method. Over 6 months of treatment, results showed that blood loss decreased significantly in COC users, both when compared with a placebo group and with a 90-day pretreatment period. This represents a new option for HMB treatment with the advantage of simultaneously providing contraception, a requirement for many women with HMB who wish to preserve their fertility. Despite these excellent results, the facts remain that HMB is a chronic medical condition and that this new therapy still requires long-term evaluation. Notwithstanding, this report is the first to describe the successful use of a COC to treat HMB, a challenging condition with limited options for conservative treatment.