title: Efficacy of fennel and combined oral contraceptive on depot medroxyprogesterone acetate-induced amenorrhea: a randomized placebo-controlled trial.
abstract: OBJECTIVE
  We aimed to determine the efficacy of fennel and low-dose combined oral contraceptive (LD-COC) on inducing menstrual bleeding and method continuation in women using depot medroxyprogesterone acetate (DMPA) who had no menstrual bleeding within the previous 45 to 140 days.
  
  
  METHODS
  In this double-blind double-dummy trial, 78 married women referred to public health centers in Hamadan, Iran, who complained of menstrual cessation induced by DMPA were randomly assigned into fennel, LD-COC or placebo groups with an allocation ratio of 1:1:1. All participants received two fennel or placebo capsules and one placebo or LD-COC pill daily for 21 days. We evaluated menstrual bleeding using the Higham pictorial chart within 40 days following initiating intervention. Data were analyzed using chi-square or analysis of variance.
  
  
  RESULTS
  There was no loss to follow-up. Significantly more women in the fennel (73%) and LD-COC (81%) groups experienced menstrual bleeding compared to the placebo (19%) group [relative risk (RR) 3.1, 95% confidence interval (CI) 1.6 to 6.2; RR 4.2, 95% CI 1.9 to 9.4, respectively]. Mean amount of menstrual bleeding among those who experienced menstruation was significantly higher in the fennel group (21 cc) than both the LD-COC (14 cc) and placebo (12 cc) groups. Also, women using fennel (73%) and LD-COC (65%) were significantly more likely than those using placebo (31%) to have subsequent DMPA injection [RR 2.5 (95% CI 1.3 to 4.9) and RR 2.0 (95% CI 1.1 to 3.7), respectively].
  
  
  CONCLUSIONS
  Fennel and LD-COC can resolve DMPA-induced amenorrhea and increase continuation rate of this contraceptive method.
authors: Department of Midwifery, Faculty of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
authors: Ensiyeh
authors: E
authors: Mohebbi-Kian
authors: Barij Medicinal Herbs Research Center, Kashan, Iran. Electronic address: alizades@tbzmed.ac.ir.
authors: Sakineh
authors: S
authors: Mohammad-Alizadeh-Charandabi
authors: Barij Medicinal Herbs Research Center, Kashan, Iran.
authors: Reza
authors: R
authors: Bekhradi
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced / Q000188:drug therapy*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D004311:Double-Blind Method; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D030001:Foeniculum; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D008598:Menstruation / Q000187:drug effects*; D008517:Phytotherapy; D010938:Plant Oils / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D010938:Plant Oils; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
keywords: Continuation; Contraception; Depo Provera; Higham; Menstrual cessation