***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study compared the efficacy of the levonorgestrel-releasing intrauterine system ( LNG-IUS ) to low dose combined oral contraceptive pills ( COC ) in the management of  idiopathic menorrhagia .  STUDY DESIGN A single-center , open , r and omized clinical trial . One hundred twelve women complaining of excessive menstruation who desired contraception were r and omized to receive LNG-IUS or COC .  Treatment failure was defined as the need for medical or surgical treatment during the follow-up . Other outcomes included : menstrual blood loss ( MBL ) by alkaline hematin and by pictorial blood assessment chart ( PBLAC ) , hemoglobin levels and assessment of lost days in which physical or mental health prevented participating women from performing usual activities . RESULTS At baseline , LNG-IUS ( n=56 ) and COC ( n=56 ) groups were comparable in age ( mean ± S.D. ) ( 39.3 ± 6.7 vs. 38.7 ± 5.2 years , p=.637 ) , parity ( median and range ) [ 3(1 - 6.4 ) vs.3(2 - 6 ) , p=.802 ] and BMI ( mean ± S.D. ) ( 29.6 ± 5.9 vs. 31.1 ± 5.7 kg/m(2 ) , p=.175 ) . Time to treatment failure was longer in LNG compared to COC group with a total of 6 ( 11 % ) patients who had treatment failure in the LNG-IUS compared to 18 ( 32 % ) in COC group with a hazard ratio of 0.30 ( 95 % CI , 0.15 - 0.73 , p=.007 ) . Using alkaline hematin , the reduction in MBL ( mean ± S.D. ) was significantly more in the LNG-IUS group ( 87.4 ± 11.3 % ) compared to the COC group ( 34.9 ± 76.9 % ) ( p=.013 ) . Utilizing PBLAC scores , the reduction in the LNG-IUS ( 86.6 ± 17.0 % ) group was significantly more compared to the COC group ( 2.5 ± 93.2 % ) ( p<.001 ) . In the LNG-IUS group , increase in the hemoglobin and ferritin levels ( mean ± S.D. ) were noted ( from 10.2 ± 1.3 to 11.4 ± 1.0 g/dL ; p<.001 ; with reduction of the number of lost days ( from 6.8 ± 2.6 to 1.6 ± 2.4 days , p=.003 ) . CONCLUSION The LNG-IUS is a more effective therapy for idiopathic menorrhagia compared to COC OBJECTIVES To compare bleeding patterns for 12 months continuous use of a contraceptive ring [ contraceptive vaginal ring ( CVR ) ] and pill [ combined oral contraceptive ( COC ) ] on a menstrually signaled regimen and the effectiveness of 4 days " treatment withdrawal " to stop bleeding . STUDY DESIGN Women , 66 to each group , were r and omized to continuous use of a CVR ( 15 mcg ethinyl estradiol/150 mcg etonogestrel ) or a low-dose pill ( 20 mcg ethinyl estradiol/100 mcg levonorgestrel ) for 360 days on a menstrually signaled regimen . Bleeding/spotting days , daily use of ring or pill , was recorded . Endpoint was the total number of bleeding/spotting days for each method over four 90-day reference periods ( RP ) plus the analysis of bleeding patterns using modified World Health Organization criteria . RESULTS There was a reduction in the mean ( ±S.D. ) number of bleeding/spotting days from RP1 ( CVR 14.2±10 ; pill 16.6±10.9 ) to RP4 ( CVR 8.8±9.6 ; pill 8.8±9.1 ) . Fifteen percent of CVR and 4 % COC users experienced amenorrhea or infrequent bleeding throughout the study . Amenorrhea increased over time ( RP1 vs. RP4 : CVR 10 % vs. 21 % and COC 2 % vs. 30 % ) . Compliance with the menstrually signaled regimen was poor . Ceasing hormones for 4 days stopped a bleeding episode within 5 days in the majority of episodes and many stopped spontaneously . CONCLUSION Bleeding patterns with continuous use of the CVR and COC are similar and improve over 1 year of use . The unpredictability , but short duration , of bleeding episodes should be stressed during counseling . IMPLICATION This information for clinicians and women about breakthrough bleeding patterns with use of a CVR or combined pill over 12 months using a menstrually signaled regimen will give women an indication of what to expect with continuous use STUDY OBJECTIVE To compare the efficacy of oral tranexamic acid ( TA ) with combined oral contraceptives ( COC ) in reducing menstrual blood loss ( MBL ) and improving quality of life in adolescent heavy menstrual bleeding ( HMB ) . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve r and omized crossover trial with 17 postmenarchal girls aged 21 years and younger with HMB who were seen at our institution . INTERVENTIONS Patients were r and omized to group A ( TA arm ) or group B ( COC arm ) , each for 3 cycles , with crossover to the second arm after 1-month washout . MAIN OUTCOME MEASURES The primary end points were difference in improvement in MBL and QOL , from baseline to end of each therapy . RESULTS Seventeen patients were enrolled ( mean age 14.2 years , range 11.7 to 16.8 years ) . Nine patients completed both arms ; 8 patients withdrew from the study due to adverse events or noncompliance . Compared with baseline , significant improvement ( P < .05 ) was demonstrated by TA and COC in MBL ( mean Pictorial Blood Assessment Chart score decrease : TA , 536.4 ; COC , 430.6 ) and quality of life ( mean Pediatric Quality of Life Inventory(TM ) version 4.0 Generic Scales score increase : TA , 15.6 ; COC , 16.75 ) , but no significant difference was noted between TA and COC ( P > .05 ) . There was statistically significant reduction in the length of menstrual cycle for COC only ( mean reduction 5.3 days ; P = .04 ) and not for TA ( P = .18 ) . Ten patients ( 58 % ) experienced adverse events that were possibly drug related ( TA : n = 3 , 30 % ; COCP : n = 7 , 64 % ) . CONCLUSION In this pilot study , oral TA appeared as efficacious as COC in the management of adolescent HMB by reducing MBL and improving quality of life 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 r and omised 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 Background The purpose of this study was to quantify the impact of estradiol-valerate/dienogest ( E2V/DNG ; Qlaira ® /Natazia ® ) on work productivity and activities of daily living in European and Australian women with heavy menstrual bleeding . Methods Women aged 18–54 years with a confirmed diagnosis of heavy menstrual bleeding and no recognizable pathology were recruited across nine European countries ( the Czech Republic , Finl and , Germany , Hungary , The Netherl and s , Pol and , Sweden , UK , and Ukraine ) and Australia . The women were r and omized to receive either E2V/DNG ( n = 149 ) or placebo ( n = 82 ) for seven treatment cycles ( 196 days ) . The outcomes assessed included work productivity ( ie , productivity while at work ) and activities of daily living , measured on a Likert scale from 0 to 10 ( with higher values denoting higher impairment levels ) at baseline and at the end of the third and seventh cycles ( days 84 and 196 ) . The equivalent monetary value associated with the changes in work productivity and activities of daily living was also calculated . Results Across all the countries , greater improvements from baseline to the end of treatment were observed with E2V/DNG treatment than placebo  in work productivity ( 46.0 % versus 15.1 % ) and activities of daily living ( 55.6 % versus 30.8 % ) . In 2008 , savings associated with improvements in work productivity and activities of daily living due to E2V/DNG treatment ( net of placebo improvement ) were estimated to be between US$ 22–62 and US$ 18–56 per month ( in purchasing power parity of US$ ) , respectively . Conclusion E2V/DNG has a consistent positive impact on work productivity and activities of daily living in European and Australian women with heavy menstrual bleeding . These improvements were associated with a reduction in monetary burden of heavy menstrual bleeding compared with the placebo group , consistent with the response to treatment observed OBJECTIVE : To compare bleeding profiles and satisfaction among women using a norelgestromin/ethinyl estradiol ( E2 ) transdermal contraceptive patch in an extended regimen to those among women using a traditional 28-day patch regimen . METHODS : Healthy , regularly menstruating women ( N = 239 ) were r and omly assigned ( 2:1 ratio ) to receive the norelgestromin/ethinyl E2 transdermal patch in an extended regimen ( weekly application for 12 consecutive weeks , 1 patch-free week , and 3 more consecutive weekly applications , n = 158 ) or a cyclic regimen ( 4 consecutive cycles of 3 weekly applications and 1 patch-free week , n = 81 ) . Subjects recorded bleeding data daily and completed satisfaction question naires . Subjects and investigators provided overall assessment s of the regimens . RESULTS : Extended use of the norelgestromin/ethinyl E2 transdermal patch result ed in fewer median bleeding days ( 6 compared with 14 , P < .001 ) , bleeding episodes ( 1 compared with 3 , P < .001 ) , and bleeding or spotting episodes ( 2 compared with 3 , P < .001 ) compared with cyclic use during days 1–84 ; median numbers of bleeding or spotting days were similar between regimens ( 14 compared with 16 , P = .407 ) during this time . Extended use delayed median time to first bleeding to 54 days compared with 25 days with cyclic ( P < .001 ) . Subjects were highly satisfied with both regimens . Although not statistically significant , slightly more adverse events were reported with the extended than with the 28-day regimen . CONCLUSION : Compared with cyclic use , extended use of the norelgestromin/ethinyl E2 transdermal patch delayed menses and result ed in fewer bleeding days . This regimen may represent a useful alternative for women who prefer fewer episodes of withdrawal bleeding . LEVEL OF EVIDENCE : OBJECTIVE To compare the efficacy of a levonorgestrel-releasing intrauterine system ( LNG-IUS ) with that of a low-dose combined oral contraceptive ( COC ) in reducing fibroid-related menorrhagia . METHODS In this single-center , open , r and omized clinical trial , 58 women with menorrhagia who desired contraception were r and omized to receive a LNG-IUS or COC . The outcomes included treatment failure , defined as the need for another treatment ; menstrual blood loss ( MBL ) by the alkaline hematin method and a pictorial assessment chart ( PBAC ) ; hemoglobin levels ; and " lost days . " RESULTS Treatment failed in 6 women ( 23.1 % ) in the LNG-IUS group and 11 ( 37.9 % ) in the COC group , for a hazard ratio of 0.46 ( 95 % CI , 0.17 - 1.17 , P=0.101 ) . Using the alkal 
    Output:
    
Minor adverse events , in particular breast pain , were more common with COCP .
There were discrepancies between some of the findings and there was no evidence of a benefit for one treatment compared to the other for response to treatment , MBL or participant satisfaction with treatment .
There was a greater likelihood of nausea with COCP .
It is possible that CVR increased the odds of satisfaction ; but we are uncertain whether CVR improved MBL .
When compared with other medical options for HMB , COCP was less effective than the LNG IUS .
Limited evidence suggested that COCP and CVR had similar effects .
There was insufficient evidence to determine comparative efficacy of combined hormonal contraceptives with NSAIDs , or long course progestogens