Combined Oral Contraceptive for Treatment of Women with Uterine Fibroids and Abnormal Uterine Bleeding: A Systematic Review

Abstract

Background/Aims: We aimed at assessing the efficacy of combined oral contraceptives (COC) in treating women with uterine leiomyomata and heavy menstrual bleeding (HMB), as well as their effect over quality of life (QoL), tumor size, and hemoglobin concentration. Methods: We searched various electronic databases and reference lists from all included studies. Randomized and nonrandomized controlled clinical trials were selected, and two trials were considered eligible - one randomized and one ‘pseudo'-randomized. Results: COCs performed less well than levonorgestrel-releasing intrauterine systems (LNG-IUSs) in controlling HMB, improving QoL, and improving the hemoglobin concentration, whereas the estimate was not sufficiently precise to define whether COCs were better than, equal to, or worse than LNG-IUSs in reducing tumor size. It must be stressed that these results are based on low-quality evidence, stemming from a single trial. Additionally, COCs were more effective than placebo in tumor size reduction, another conclusion based on another single study, considered as being at a high risk of bias and judged as very low-quality evidence. Conclusion: Evidence regarding the use of COCs as treatment for women with symptomatic fibroids is very scarce and of low quality, and we are very uncertain about the real efficacy of such treatment.