title: Comparison of combined hormonal vaginal ring with ultralow-dose combined oral contraceptive pills in the management of heavy menstrual bleeding: A pilot study.
abstract: The aim of this study was to compare combined hormonal vaginal ring with ultralow-dose combined oral contraceptive (COC) pills in management of heavy menstrual bleeding (HMB). Fifty patients were randomised into Group I: vaginal ring (n = 25) and group II: COC pills (n = 25). Menstrual blood loss (MBL) was assessed at baseline, 1, 3 and 6 months (while on treatment) and at 9 months (3 months after stopping therapy). There was significant reduction in baseline pictorial blood loss assessment chart (PBAC) score from 440 ± 188 (Mean ± SD) to 178 ± 95, 139 ± 117, 112 ± 84 and 120 ± 108 in group I and from 452 ± 206 to 204 ± 152, 179 ± 125, 176 ± 164 and 202 ± 167 in group II at 1, 3, 6 and 9 months, respectively (p = 0.001). Reduction in MBL was 72% and 62% at 6 months and up to 71% and 55% at 9 months in group I and group II, respectively (p = 0.001). Reduction in MBL with ring was greater at higher baseline PBAC score but lesser in patients with fibroid > 2 cm. Combined vaginal hormonal treatment for HMB is as effective as oral hormonal therapy, with minor and transient side effects and persistence of response after cessation of therapy.
authors.affiliation: a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: N
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: M
authors.initials: M
authors.lastname: Gupta
authors.affiliation: a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: A
authors.initials: A
authors.lastname: Kriplani
authors.affiliation: a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: N
authors.initials: N
authors.lastname: Bhatla
authors.affiliation: a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India.
authors.forename: N
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D003274:Contraceptive Devices, Female; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D017135:Desogestrel / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004338:Drug Combinations; D004997:Ethinyl Estradiol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy*; D010865:Pilot Projects
chemical_list: D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; C516519:NuvaRing; D004997:Ethinyl Estradiol; D017135:Desogestrel
keywords: Combined hormonal vaginal ring; etonogestrel; heavy menstrual bleeding; pictorial blood loss assessment chart; ultralow-dose combined oral contraceptive pills