***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 OBJECTIVE : To compare the efficacy and safety of the levonorgestrel-releasing intrauterine system and oral medroxyprogesterone acetate in the treatment of idiopathic heavy menstrual bleeding . METHODS : In this multicenter , r and omized , controlled study , women aged 18 years or older with heavy menstrual bleeding ( menstrual blood loss 80 mL or more per cycle ) were r and omly assigned to six cycles of treatment with either levonorgestrel-releasing intrauterine system or oral medroxyprogesterone acetate ( 10 mg daily for 10 days beginning on day 16 of each cycle ) . The primary efficacy variables were the absolute change in menstrual blood loss from baseline to end of study and the proportion of women with successful treatment ( defined as menstrual blood loss less than 80 mL and a 50 % or greater reduction in menstrual blood loss from baseline ) . RESULTS : Of 807 women screened , 165 were r and omly assigned to treatment ( levonorgestrel-releasing intrauterine system n=82 , oral medroxyprogesterone acetate n=83 ) . At the end of the study , the absolute reduction in median menstrual blood loss was significantly greater in the levonorgestrel-releasing intrauterine system group ( −128.8 mL , range −393.6 to + 1242.2 mL ) than in the medroxyprogesterone acetate arm ( −17.8 mL , range −271.5 to + 78.6 mL , P < .001 ) , and the proportion of women with successful treatment was significantly higher for the levonorgestrel-releasing intrauterine system ( 84.8 % ) than for medroxyprogesterone acetate ( 22.2 % , P < .001 ) . CONCLUSION : In women with idiopathic heavy menstrual bleeding , the levonorgestrel-releasing intrauterine system  reduces menstrual blood loss more effectively and has a higher likelihood of treatment success than oral medroxyprogesterone acetate . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00360490 . LEVEL OF EVIDENCE : OBJECTIVE To compare the effects of low-dose oral contraceptives used alone and in combination with a gonadotropin-releasing hormone ( GnRH ) analog to treat heavy menstrual bleeding . METHODS Fifty-eight patients with heavy menstrual bleeding were prospect ively r and omized into two treatment groups to receive either a low-dose oral contraceptive alone ( group 1 ) , or combined with a GnRH analog ( group 2 ) for 6 months . The patients ' hormonal profiles , and hemoglobin and hematocrit levels were measured at the beginning and at the end of the treatment period . RESULTS Hemoglobin and hematocrit levels significantly improved in both groups after 6 months of treatment ( P<0.05 and P<0.01 , respectively ) . Even in the first month of the study , the number of pads used and the duration of menstruation were significantly decreased in both groups and markedly lower in group 2 ( P<0.01 ) . CONCLUSION The addition of a GnRH analog to low-dose oral contraceptive treatment for heavy menstrual bleeding result ed in better control of vaginal bleeding , even in the first month of therapy OBJECTIVE : To assess the efficacy and safety of an oral formulation of tranexamic acid for the treatment of heavy menstrual bleeding . METHODS : Adult women with heavy menstrual bleeding ( mean menstrual blood loss 80 mL or more per cycle ) were enrolled in a double-blind , placebo-controlled study . After two pretreatment menstrual cycles , women were r and omized to receive tranexamic acid 3.9 g/d or placebo for up to 5 days per menstrual cycle through six cycles . To meet the prespecified three-component primary efficacy end point , mean reduction in menstrual blood loss from baseline with tranexamic acid treatment needed to be 1 ) significantly greater than placebo , 2 ) greater than 50 mL , and 3 ) greater than a predetermined meaningful threshold ( 36 mL or higher ) . Health-related quality of life was measured using a vali date d patient-reported outcome instrument . RESULTS : Women who received tranexamic acid ( n=115 ) met all three primary efficacy end points : first , a significantly greater reduction in menstrual blood loss of −69.6 mL ( 40.4 % ) compared with −12.6 mL ( 8.2 % ) in the 72 women who received placebo ( P<.001 ) ; reduction of menstrual blood loss exceeding a prespecified 50 mL ; and last , reduction of menstrual blood loss considered meaningful to women . Compared with women receiving placebo , women treated with tranexamic acid experienced significant improvements in limitations in social or leisure and physical activities , work inside and outside the home , and self-perceived menstrual blood loss ( P<.01 ) . The majority of adverse events were mild to moderate in severity , and the incidence of gastrointestinal adverse events was comparable with placebo . CONCLUSION : In this study , a new oral tranexamic acid treatment was well tolerated and significantly improved both menstrual blood loss and health-related quality of life in women with heavy menstrual bleeding . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00386308 . LEVEL OF EVIDENCE : OBJECTIVE Our purpose was to compare the efficacy of the recommended dose of danazol , a reduced-dose danazol regimen , and norethindrone in the treatment of objective ly proven menorrhagia . Recurrence after discontinuing treatment was also assessed . STUDY DESIGN The study was a single-blind , r and omized , parallel , comparative study . After a placebo run-in period over two menstrual cycles , 57 patients with a baseline mean menstrual blood loss of at least 80 ml per cycle were r and omly assigned to receive one of three therapies : danazol , 200 mg/day ( n = 19 ) for three menstrual cycles ; danazol , 200 mg/day for one cycle , 100 mg/day for one cycle , and 50 mg/day for one cycle ( n = 19 ) ; and norethindrone , 5 mg three times daily on days 19 through 26 of the cycle for three consecutive cycles ( n = 19 ) . Patients in whom treatment was successful ( those experiencing blood loss < 80 ml ) were entered in the follow-up phase of the study , receiving placebo for a maximum of four menstrual cycles . RESULTS The final menstrual blood loss on treatment was significantly less for those patients who received both danazol regimens compared with those who received norethindrone ( p = 0.017 for reducing dose danazol vs norethindrone and p = 0.043 for 200 mg of danazol vs norethindrone ) . Both danazol treatment regimens were significantly more successful in reducing menstrual blood loss to within the normal range than was norethindrone . The reducing-dose danazol regimen was successful in eight of 17 patients ( p = 0.027 ) , and 200 mg of danazol was successful in nine of 19 patients ( p = 0.029 ) , compared with the two successes of 18 patients treated with norethindrone . Significantly more recipients of 200 mg of danazol than of norethindrone subjectively rated their treatment to be moderately or highly effective ( p = 0.033 ) . Both danazol treatment regimens were associated with a higher incidence of adverse events than was norethindrone therapy , although the number of withdrawals were similar and infrequent in the three groups . CONCLUSIONS Both danazol regimens were significantly more effective than norethindrone in reducing the excessive menstrual blood loss of women with unexplained menorrhagia . A subjective assessment by patients found that only the 200 mg of danazol was judged to be significantly more effective than norethindrone in controlling the heaviness of menstrual bleeding . The reduced-dose danazol regimen did not appear to markedly diminish the incidence of adverse events compared with the 200 mg of danazol regimen BACKGROUND This double-blind trial investigated the efficacy and safety of estradiol valerate/dienogest ( E(2)V/DNG ) for the treatment of heavy menstrual bleeding without recognizable organic pathology . METHODS Otherwise healthy women with idiopathic heavy , prolonged or frequent menstrual bleeding , confirmed during a 90-day run-in phase , were r and omized ( 2:1 ) according to a permuted-block , computer-generated schedule to E(2)V/DNG or placebo for 196 days at 34 centres in Europe and Australia . The primary efficacy end-point was the proportion of women with a ' complete ' response ( i.e. a return to ' menstrual normality ' ) during a 90-day efficacy phase . Secondary end-points included changes in measured menstrual blood loss ( MBL ) and iron metabolism parameters . RESULTS The intention-to-treat population comprised 231 women . The  E(2)V/DNG response rate was much higher than with placebo ( P < 0.0001 ) . The mean reduction in MBL volume in E(2)V/DNG recipients was 69.4 % ( median 79.2 % ) versus 5.8 % ( median 7.4 % ) in placebo recipients . The between-treatment difference in MBL volume was 373 ml in favour of E(2)V/DNG ( 95 % confidence interval 490 , 255 ml ; P < 0.0001 ) . Significant improvements in iron metabolism parameters were observed with E(2)V/DNG but not placebo . Overall , 14 women ( 9.7 % ) treated with E(2)V/DNG and 5 ( 6.2 % ) treated with placebo prematurely discontinued treatment because of adverse events , headache being the most prevalent . Serious adverse events occurred in both the E(2)V/DNG and placebo groups ( each n = 2 ) . CONCLUSIONS E(2)V/DNG is an effective treatment in women with heavy and /or prolonged menstrual bleeding without organic pathology . Further study of E(2)V/DNG compared with an active comparator is warranted . Clinical Trials.gov identifier : NCT00307801 Summary : A series of 45 ovulatory women with a complaint of menorrhagia were r and omized into 3 treatment groups , before 
    Output:
    
The levonorgestrel intrauterine system , combined OCPs , and antifibrinolytics were all superior to luteal-phase progestins ( 20 % increase in bleeding to 67 % reduction ) .
The levonorgestrel intrauterine system was superior to combined OCPs and NSAIDs .
Antifibrinolytics were superior to NSAIDs for menstrual bleeding reduction .