Continuous OC regimen eyed for dysmenorrhea
Dysmenorrhea affects up to 80% of reproductive age women, with social and occupational roles often impacted by the pain associated with the condition.1 Clinicians are familiar with the condition: In a study of young women attending a family planning clinic, 72% of those surveyed said they had experienced dysmenorrhea, with 15% stating that symptoms were severe enough to interfere with normal activities.2
A new study looks at the impact of continuous regimen oral contraceptives (OCs) in providing earlier relief for moderate to severe menstrual cramps.3 Taking oral contraceptives continuously, rather than traditionally prescribed for each cycle, provided earlier relief for moderate to severe menstrual cramps, researchers report.
The study was designed as a double-blind, randomized, controlled trial comparing continuous to a cyclic 21-7 oral contraceptive regimen (gestodene 0.075 mg and ethinyl estradiol 20 mcg) for six months in 38 primary dysmenorrhea patients. Participants were recruited from the Obstetrics and Gynecology Department at Nova Gradiska General Hospital in Croatia from December 2007 to May 2010. The primary outcome was the difference in subjective perception of pain as measured by a visual analog scale over a six-month period. Gestodene-containing oral contraceptives are not available in United States; however, they are marketed in Croatia, where the study was conducted. Researchers from BetaPlus Center for Reproductive Medicine in Zagreb, Croatia, and the Departments of Obstetrics and Gynecology and Public Health Sciences at Penn State University College of Medicine in Hershey, PA, chose the formulation since it was the only low-dose OC available for use in Croatia, where the study was conducted.
Women recruited for the trial were ages 18-35 with a history of primary dysmenorrhea and regular menstrual cycles. Thirty-eight women were randomized; 29 completed the study. In both groups, researchers note pain reduction, measured by visual analog scale, declined over time and was significant at six months compared with baseline, with no difference between groups. Data indicates the continuous regimen was superior to cyclic regimen after one month (mean difference -27.3, 95% confidence interval [CI] -40.5 to -14.2; P less than .001) and three months of treatment (mean difference -17.8, 95% CI -33.4 to -2.1; P=.03). After six months, data indicates an increase in weight and a decrease in systolic blood pressure in the continuous group compared with the cyclic group; both findings registering a P value less than 0.5.3
Further multi-center studies are indicated in looking at continuous regimen pills for dysmenorrhea, says study co-author, Richard Legro, MD, professor of obstetrics and gynecology at Penn State University. "Any treatment that brings more rapid and more complete pain relief is worth pursuing as a primary treatment, even if the end result after six months is the same," says Legro. "Certainly our findings support that continuous oral contraceptives achieve an earlier optimal pain relief response than traditional cyclic pills."
What do you choose?
Prostaglandin synthetase inhibitors such as non-steroidal anti-inflammatory drugs (NSAIDs) and Cox-2 inhibitors are more effective than placebo in treating dysmenorrhea. About 80% of women feel relief with these agents.4 For women with primary dysmenorrhea who use NSAIDs for pain relief, research indicates continuous regimen pills alleviate the need for such drugs and eliminate the risk for gastrointestinal symptoms associated with them.5
Continuous regimens are effective for symptom relief. A 2005 review of available research regarding extended use/continuous use pills showed that menstrual symptoms, such as headaches, tiredness, bloating, and cramping, improved with such regimens, said Eva Lathrop, MD, MPH, assistant professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine in Atlanta.6 Lathrop spoke at the 2011 Contraceptive Technology Quest for Excellence conference.7
Despite their effectiveness, use of extended/continuous OC regimens is not the norm. A 2011 survey of Oregon physicians found that half prescribed such regimens sometimes, with 23% indicating such use as "often."8
More education on extended/continuous regimens might be needed. Most respondents (68%) did not realize that menstrual-related symptoms are most common during the placebo week, and 17% of respondents did not know that endometrial thickening does not occur with extended-use pills.8
References
- Bettendorf B, Shay S, Tu F. Dysmenorrhea: contemporary perspectives. Obstet Gynecol Surv 2008; 63(9):597-603.
- Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144(6):655-660.
- Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol 2012; 119(6):1,143-1,150.
- Nelson AL, Cwiak C. Combined oral contraceptives (COCs). In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011:266.
- Edelman AB, Gallo MF, Jensen JT, et al. Continuous or extended cycle vs. cyclic use of combined oral contraceptives for contraception. Cochrane Database Syst Rev 2005; 3:CD004695.
- Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception 2010; 81(3):185-196.
- Lathrop E. How to choose a good fit pill. Presented at the Contraceptive Technology Quest for Excellence conference. Atlanta; November 2011.
- Frederick CE, Edelman A, Carlson NE, et al. Extended-use oral contraceptives and medically induced amenorrhea: attitudes, knowledge and prescribing habits of physicians. Contraception 2011; 84(4):384-389.
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