Heavy menstrual bleeding (HMB) can cause anaemia (too few red blood cells) and interfere with a woman's quality of life and well‐being. Combined oral contraceptive pills (COCP) can provide control of the menstrual cycle by thinning the endometrium (the lining of the womb that is shed during menstruation). The updated Cochrane review investigated the efficacy and safety of COCP and other treatments for HMB.  Moderate‐quality evidence suggests that COCP over six months reduces HMB from 12% to 77% (compared to 3% in women taking placebo). Minor adverse events, in particular breast pain, are more common with COCP than with placebo. There is insufficient evidence to determine comparative efficacy of hormonal treatment with non‐steroidal anti‐inflammatory drugs (NSAIDs), or long course oral progestogens. Low-quality evidence suggests levonorgestrel‐releasing intrauterine system (LNG IUS) is more effective than COCP at reducing menstrual blood loss.

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