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19-01-2012 | Legal medicine | Article

Contraceptive pill could help reduce severity of dysmenorrhea


Free abstract

MedWire News: The combined oral contraceptive pill (COC) could help reduce the severity of dysmenorrhea, say Swedish researchers.

Although COCs are advocated as treatment for primary dysmenorrhea, their efficacy has been questioned in a Cochrane review, explain Ingela Lindh and colleagues from Gothenburg University.

They administered postal questionnaires concerning weight/height and reproductive factors such as contraception, reproductive history, and menstrual pattern to random samples of 19-year-old women born in 1962 (n=656), 1972 (n=780), and 1982 (n=666) in Gothenburg.

These women were assessed again 5 years later at the age of 24 years. On each occasion, the severity of their dysmenorrhea was determined using a verbal multidimensional scoring system (VMS) that grades pain as none, mild, moderate or severe, takes into account the effect on daily activity, and whether any painkillers were required.

Dysmenorrhea severity was also assessed using the visual analog scale (VAS) where the degree of pain is graded on a 10 cm line that starts with "no pain at all" and ends with "unbearable pain."

The findings, reported in Human Reproduction, revealed that the severity of dysmenorrhea was significantly lower in COC users than in nonusers.

Longitudinal analysis revealed that COC use and increasing age (from 19-24 years), independently of each other, were associated with reduced severity of dysmenorrhea.

Indeed, when using the VMS system, COC use resulted in a significant 0.3-unit reduction in the severity of dysmenorrhea and increased age resulted in a significant reduction of 0.1 units. When using VAS as a dependent variable, COC use resulted in a significant decrease of 9 mm and increased age resulted in a significant reduction of 5 mm.

Childbirth also significantly reduced the severity of dysmenorrhea, by 7mm, but only when using the VAS system.

Compared with the 1962 and 1972 cohorts, more women in the 1982 cohort reported suffering from dysmenorrhea and the severity of their symptoms was significantly worse, according to both VAS and VMS scores.

"We are unsure why this is. It may be due to changes in the type of oral contraceptive used, for example, differences in estrogen content and progestogen type, or a different appreciation of pain in the women born in later years," commented Lindh in a press statement.

She emphasized that dysmenorrhea has a detrimental effect on women's lives, causing regular absenteeism from school and work, and interfering with daily activities.

"Therefore effective management of dysmenorrhea is beneficial for both the woman affected and society."

Although approved for contraception by the European Medicines Agency and the US Food and Drug Administration, COC is currently prescribed 'off-label' for the alleviation of dysmenorrhea symptoms.

However, drug companies are presently discussing the prospect of a randomized controlled trial to evaluate COC use in the treatment of dysmenorrhea. Nonetheless, the absence of a randomized trial "in no way" reduces the value of their findings, commented Lindh.

"Information about the effects of COC use on painful periods should be included in contraceptive counseling, as it has been shown that women who experience a beneficial effect of COCs other than contraception, such as a reduction in dysmenorrhea, are more likely to continue with the pill," she added.

By Piriya Mahendra

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