Teens & dysmenorrhea: Look to low-dose OCs
The 15-year-old young woman in your exam room tells you that she has crampy pelvic pain that begins shortly before or at the onset of her menstrual period that lasts one to three days. She says she usually misses a day of school each month due to the pain. What is your next move?
Primary dysmenorrhea, or painful menses in women with normal pelvic anatomy, usually begins during adolescence.1 Some 20% to 90% of all female adolescents experience dysmenorrhea,2-4 and it is the leading cause of recurrent short-term school absenteeism in U.S. adolescent girls.3,5
New research indicates that today’s low-dose (20 mcg) oral contraceptives (OCs) are an effective treatment choice for moderate to severe dysmenorrhea in adolescents.6 The research offers one of the first looks at use of current pills; earlier studies focused on use of higher-dose pills.7
While nonsteroidal anti-inflammatory medications represent an effective course of treatment for painful menstrual cramps in teens, birth control pills have the added benefits of treating or preventing three common conditions in female adolescents: irregular bleeding, acne, and unintended pregnancies, reports Andrew Kaunitz, MD, professor and assistant chair in the Department of Obstetrics and Gynecology at the University of Florida Health Science Center/Jacksonville.
Teenagers may especially benefit from using the Pill for treatment of dysmenorrhea, since they seem to have more burden of pain and disability from dysmenorrhea than older women, observes Anne Davis, MD, assistant professor of obstetrics and gynecology at Columbia Presbyterian Medical Center in New York City and lead author of the current research.
Review the research
The new study reports the results of a randomized, double-blind, placebo-controlled clinical trial of 76 healthy adolescents age 19 or younger with moderate or severe dysmenorrhea. The teens were randomly allocated to receive a 20 mcg ethinyl estradiol OC or a matching placebo for three months, and they were allowed to use their usual pain medications as needed during the trial.
By cycle three, OC users reported fewer days of any pain, fewer days of severe pain, and fewer hours of pain on the worst pain day than placebo users; however, these differences did not reach statistical significance, state the researchers.6 No serious adverse events related to Pill use were noted. Two teens in the pill group discontinued use due to such side effects as nausea and acne. One teen using the placebo stopped treatment due to moodiness.
Pills are effective in relieving primary dysmenorrheal. Most women have moderate to complete relief within a few months after starting OC use.8 Teens who experience relief from menstrual cramping are more likely to use the Pill consistently and correctly.9
But do teens know of the Pill’s noncontraceptive benefits? According to a 1998 survey, half of the respondents were not aware of any OC benefits beyond preventing pregnancy.10
Remind teens that combination OCs can have a beneficial effect on a number of conditions that can affect their quality of life, including benign breast disease, functional ovarian cysts, iron deficiency anemia, acne, and menstrual irregularity.11 Also, tell teens that pills are just as safe in adolescents as they are in older women, says Davis.
How about new methods?
How do new methods such as the transdermal contraceptive (Evra, Ortho-McNeil Pharmaceutical, Raritan, NJ) impact primary dysmenorrhea in teens? Results from a small study of adolescent girls using the contraceptive patch indicate that about 40% reported a decrease in dysmenorrhea symptoms.12
More research needs to be conducted to determine if the contraceptive patch and ring provide similar efficacy in relieving the condition, says Kaunitz.
Teens who are not good candidates for hormonal contraception may look to nonsteroidal anti-inflammatory drugs for relief of dysmenorrhea.13 These drugs are effective in inhibiting prostaglandin synthesis and decrease the volume of menstrual flow.1
References
- French L. Dysmenorrhea. Am Fam Physician 2005; 71:285-291.
- Davis AR, Westhoff CL. Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives. J Pediatr Adolesc Gynecol 2001; 14:3-8.
- Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med 2000; 154:1,226-1,229.
- Strinic T, Bukovic D, Pavelic L, et al. Anthropological and clinical characteristics in adolescent women with dysmenorrhea. Coll Antropol 2003; 27:707-711.
- Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981; 68:661-664.
- 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.
- Proctor ML, Roberts H, Farquhar CM. Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 2001; 3(4):CD002120.
- Larsson G, Milsom I, Lindstedt G, et al. The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status. Contraception 1992; 46:327-334.
- 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 Gynecol 1992; 166:578-583.
- Association of Professors of Gynecology and Obstetrics. Gallup survey finds health benefits are the best kept secret of the pill. Press release. Washington, DC: APGO, Oct. 6, 1998.
- American College of Obstetricians and Gynecologists. Oral contraceptive use for adolescents: Benefits and safety. ACOG Educational Bulletin 1999; No. 256.
- Harel Z, Riggs S, Vaz R, et al. Adolescents’ experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra. Pediatr Adolesc Gynecol 2005; 18:85-90.
- Proctor M, Farquhar C. Dysmenorrhoea. Clin Evid 2002; (7):1,639-1,653.
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