Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. The COVID-19 pandemic has presented many challenges for healthcare systems. Interventions which were routinely delivered before 2020 are now difficult to administer and it is important to identify the effectiveness of interventions that are available. One way to do this is through focused overviews of existing reviews and this was done in July 2020 for interventions for heavy menstrual bleeding. In this podcast, Dr Martin Hirsch from University College Hospitals talks to Dr James Duffy from King’s Fertility about the findings.

Martin: Hello James, perhaps you could begin by saying a few words about why your overview is so important at this time
James: The COVID-19 pandemic has presented many challenges for health systems. Contingency planning has focused on the need to completely reconfigure and repurpose local services. This has profoundly impacted upon the specialist treatment available for many people, including the one in three women who experience heavy menstrual bleeding. 
Before the pandemic, guidelines and patient information was prepared with the expectation that a full range of treatments would be available. Unfortunately, many treatments are no longer possible during a pandemic. Treatments which are commonly used during a pandemic have not been fully considered within published guidelines and patient information.

Martin: So how does your overview help?
James: The Cochrane Gynaecology and Fertility Group has prepared many reviews assessing a wide range of treatments for heavy menstrual bleeding. Our overview has summarised the evidence base for treatments that can continue during pandemics in a single coherent document. We hope that it will improve professional, patient, and public understanding of the effectiveness and safety of treatments for heavy menstrual bleeding that typically continue during pandemics.

Martin: What did you find?
James: Drawing on evidence from over 3000 women in 44 randomised trials, it is clear that antifibrinolytics and combined hormonal contraceptives are more effective in reducing heavy menstrual bleeding than placebo. NSAIDs may also reduce heavy menstrual bleeding when compared with placebo. However, all treatments are associated with side effects.

Martin: So, what does this mean for women with heavy menstrual bleeding and their healthcare practitioners during the pandemic?
James: In general terms, antifibrinolytics, NSAIDs, and combined hormonal contraceptives can be offered to women and it is also important that their preferences, circumstances, and values should inform the selection of the most appropriate treatment.

Martin: And, finally, are there are any next steps for the overview and where can people find it if they want to learn more?
James: A network meta-analysis may be useful as it would allow us to compare the interventions in a single step and, perhaps, help us to rank them by their relative effectiveness and safety.
In regard to finding the overview, all Cochrane Reviews are available online at Cochrane Library dot com. A simple search for ‘pandemics and heavy menstrual bleeding’ will identify the review.