COCs do help relieve dysmenorrhea

Combined oral contraceptives (COCs) reduce menstrual pain in some women, a Swedish long-term study has found. Although COCs are commonly recommended to treat primary dysmenorrhea, a 2009 Cochrane Review called their efficacy into question.

The longitudinal, case-control study at Gothenburg University followed 3 groups of 19-year-old women recruited in 1981 (656 women born in 1962), 1991 (780 women born in 1972), and 2001 (666 women born in 1982) who returned an initial questionnaire asking about weight and height, contraception, pregnancy history, and other reproductive health factors. They were reassessed by questionnaire 5 years later. Current severity of dysmenorrhea was evaluated on both occasions using a verbal multidimensional scoring (VMS) system and visual analog scale (VAS).

COC use and increasing age were independently associated with less pain, as was childbirth. COC use decreased severity of pain more than the other 2 factors. Women born in 1982 reported more severe pain at both 19 and 24 years of age than those born in 1962 and 1972. The study was published online January 17 in Human Reproduction.

Although the exact difference in pain was difficult to measure, “the decrease in the severity of dysmenorrhea achieved by COCs was equivalent to the transfer of every third woman one step down on the VMS scale, which-in clinical terms-will result in less pain, improved working ability, and a decrease in the need for analgesics,” the authors write. “Effective management of dysmenorrhea is beneficial for both the afflicted individual and society, and thus the possibility of a beneficial influence of COCs on dysmenorrhea should be included in contraceptive counseling.” However, they caution that their results should be confirmed by a randomized, placebo-controlled trial with efficacy of COCs in dysmenorrhea as the primary outcome measure. 

The authors suggest including information about the effect of COCs on dysmenorrhea in counseling about their noncontraceptive benefits because women who experience relief of menstrual pain while using COCs are more likely to continue using them.

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