Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Women with suspected or diagnosed fibroids
Intervention: Levonorgestrel intrauterine device
Comparison: Norethindrone or combined oral contraceptives
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Levonorgestrel intrauterine device versus norethindrone | ||
Pictorial Blood Loss Assessment Chart (PBAC) score change from baseline after 6 months of treatment | Favors intervention | Very Low |
Levonorgestrel intrauterine device versus combined oral contraceptive | ||
Health-related Quality of Life - 4 questionnaire (HRQoL-4): self-rated health good or excellent at 12 months | No statistically significant difference | Very Low |
HRQoL-4: no. of days in the previous 30 days feeling physically unwell, change from baseline at 12 months | Favors intervention | Very Low |
HRQoL-4: no. of days in the previous 30 days feeling mentally unwell, change from baseline at 12 months | Favors intervention | Low |
HRQoL-4: no. of lost days in the previous 30 days, change from baseline at 12 months | Favors intervention | Low |
PBAC score change from baseline at 12 months | Favors intervention | Very Low |
Menstrual blood loss in ml: alkaline hematin (AH) method change from baseline at 12 months | Favors intervention | Moderate |
Recommendations as stated in the source guideline The guideline committee states: consider a levonorgestrel intrauterine device as the first treatment for heavy menstrual bleeding in women with: no identified pathology OR fibroids less than 3 cm in diameter, which are not causing distortion of the uterine cavity OR suspected or diagnosed adenomyosis. Note that this is an off-label use for some levonorgestrel intrauterine devices in the UK.
Note The guideline committee stated that the aim of managing heavy menstrual bleeding was to improve quality of life, HRQoL was therefore categorised as a critical outcome. Reduction in blood loss was categorised as an important outcome.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the effects of selective progesterone receptor modulators (SPRMs) for premenopausal women with uterine fibroids?
- Is there RCT evidence to support the use of uterine artery embolization (UAE) in women with symptomatic uterine fibroids?
- In women with benign gynecological disease, how do different approaches to hysterectomy compare at improving outcomes?
- In women undergoing surgery for uterine fibroids, how do preoperative gonadotropin-releasing hormone analogues (GnRHa) compare with placebo or no treatment?
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