Study confirms impact of OCs on dysmenorrhea
Results from a large, long-running Scandinavian study provides convincing evidence that combined oral contraceptives (OCs) alleviate the symptoms of dysmenorrhea, painful menstrual periods.1
Although results of earlier studies have suggested that combined OCs could have an impact on painful periods, a 2009 review of available research concluded there was limited evidence for pain improvement with use of the Pill in women with dysmenorrhea.2
Having definitive evidence helps clinicians move forward in addressing this common concern. Dysmenorrhea occurs frequently, particularly in young women; in some studies, up to 91% of female adolescents report painful periods.3,4
The current research stems from a Scandinavian study that has been running for 30 years.5 To perform the 2012 study, researchers from the University of Gothenburg questioned three groups of women who reached age 19 in 1981, 1991, and 2001. Each group included some 400 to 520 women, who provided information on height, weight, reproductive history, pattern of menstruation and menstrual pain, and contraceptive use. The women were assessed again at age 24.
Each woman was her own control
By comparing the same women at two ages, the scientists were able to use each woman as her own control, which allowed them to establish whether any reduction in severity of symptoms was due to Pill use or increasing age. Current severity of dysmenorrhea was measured on each occasion by a verbal multidimensional scoring system and by a visual analogue scale.
In the 2009 review of all available data, reviewers noted earlier data from the original Swedish study indicating a lower prevalence and severity of dysmenorrhea in women who were Pill users.5 The 2009 review concluded the efficacy of combined pills against dysmenorrhea could be attributed to the passage of time, notes Ingela Lindh, SRN, SRM, a researcher at the Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg. To test that conclusion, the 2012 research team analyzed data taking into account the influence of time as a confounding factor, states Lindh, lead author of the current paper. Its conclusion? Combined oral contraceptives, independent of age, influence the prevalence and severity of dysmenorrhea, states Lindh.
In a 2011 analysis of data from the 2006–2008 National Survey of Family Growth, 31% of all pill users ages 15-44 said they used OCs for cramps or menstrual pain.6 In the case of teens, 54% said they chose OCs primarily for menstrual pain.
Current low-dose (20 mcg) oral contraceptives are an effective treatment choice for moderate to severe dysmenorrhea in adolescents, according to a 2005 study.7 The paper was one of the first looks at current pills; earlier studies focused on higher-dose formulations.
For women with heavy periods, pain is the most commonly reported problem.8 The more severe a woman's pain is, the more effective combined oral contraceptives are in reducing her symptoms; research indicates a reduction of almost 90% in severe dysmenorrhea.9
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) might be a first-line choice for women with painful periods who don't wish to use a contraceptive method.10 However, for women who wish pregnancy prevention, combined OCs are the preferential therapy for pain relief from dysmenorrhea. Pills confer the additional noncontraceptive benefit of pain relief from dysmenorrhea, are not linked to additional risks, eliminate the risks associated with taking NSAIDs, and are a more suitable long-term option for women with dysmenorrhea.10
References
- Lindh I, Ellström AA, Milsom I. The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. Hum Reprod 2012. Doi: 10.1093/humrep/der417.
- Wong CL, Farquhar C, Roberts H, et al. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2009; (4):CD002120.
- Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gyencol 1982; 144:655-660.
- Parker M, Sneddon A, Arbon P. The menstrual disorder patterns of teenagers (MDOT) study: Determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2010; 117:185-192.
- Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144:655-660.
- Jones RK. Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills. New York: Guttmacher Institute; 2011.
- Davis AR, Westhoff C, O'Connell K, et al. Oral contraceptives for dysmenorrhea in adolescent girls: A randomized trial. Obstet Gynecol 2005; 106: 97-104.
- Santer M, Wyke S, Warner P. What aspects of periods are most bothersome for women reporting heavy menstrual bleeding? Community survey and qualitative study. BMC Womens Health 2007; 7:8.
- Robinson JC, Plichta S, Weisman CS, et al. Dysmenorrhea and use of oral contraceptives in adolescent women attending a family planning clinic. Am J Obstet Gynecol1992; 166:578-583.
- Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception 2010; 81:185-196.
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