title: Progestogens with or without oestrogen for irregular uterine bleeding associated with anovulation.
abstract: BACKGROUND
  Irregular menstrual bleeding may arise due to exogenous sex steroids, lesions of the genital tract or be associated with anovulation. Irregular bleeding due to oligo/anovulation (previously called dysfunctional uterine bleeding or DUB) is more common at the extremes of reproductive life, and in women with ovulatory disorders such as polycystic ovary syndrome (PCOS). In anovulatory cycles there may be prolonged oestrogen stimulation of the endometrium without progesterone withdrawal and so cycles are irregular and bleeding may be heavy. This is the rationale for using cyclical progestogens during the second half of the menstrual cycle, in order to provoke a regular withdrawal bleed. Continuous progestogen is intended to induce endometrial atrophy and hence to prevent oestrogen-stimulated endometrial proliferation. Progestogens, and oestrogens and progestogens in combination, are widely used in the management of irregular menstrual bleeding, but the regime, dose and type of progestogen used vary widely, with little consensus about the optimum treatment approach.
  
  
  OBJECTIVE
  To determine the effectiveness and acceptability of progestogens alone or in combination with oestrogens in the regulation of irregular menstrual bleeding associated with oligo/anovulation.
  
  
  METHODS
  We searched the following databases in February 2012: Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and reference lists of articles.
  
  
  METHODS
  All randomised controlled trials of progestogens (via any route) alone or in combination with oestrogens in the treatment of irregular menstrual bleeding associated with oligo/anovulation.
  
  
  METHODS
  Study quality assessment and data extraction were carried out independently by two review authors. All authors were experts in the content of this review.
  
  
  RESULTS
  No randomised trials were identified that compared progestogens with oestrogens and progestogens or with placebo in the management of irregular bleeding associated with oligo/anovulation.
  
  
  CONCLUSIONS
  There is a paucity of randomised studies relating to the use of progestogens and of oestrogens and progestogens in combination in the treatment of irregular menstrual bleeding associated with anovulation. There is no consensus about which regimens are most effective. Further research is needed to establish the role of these hormonal treatments in the management of this common gynaecological problem.
authors.affiliation: The University ofMelbourne, The RoyalWomen’sHospital,Melbourne, Australia. Martha.Hickey@thewomens.org.au.
authors.forename: Martha
authors.initials: M
authors.lastname: Hickey
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Higham
authors.forename: Ian
authors.initials: I
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000858:Anovulation / Q000150:complications*; D004359:Drug Therapy, Combination / Q000379:methods; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology; D011372:Progestins / Q000627:therapeutic use*
chemical_list: D004967:Estrogens; D011372:Progestins