A large Scandinavian study lasting more than 30 years has provided convincing evidence that the combined oral contraceptive pill alleviates the symptoms of dysmenorrhoea.
Although some previous studies and anecdotal evidence have suggested the combined oral contraceptive pill could have an impact on painful periods, a 2009 review of all available research by the Cochrane Collaboration concluded there was limited evidence for pain improvement.
The new findings by Ingela Lindh, RN, PhD, and her colleagues at Gothenburg University in Sweden show that women who used the combined oral contraceptive pill suffered less severe pain than women who did not use it.
Young women often seem to suffer more from painful periods than older women, and the researchers also found that increasing age alleviated the symptoms. But the effects of pill use and age were independent of each other, with the pill having a greater effect.
The researchers questioned three groups of women who turned 19 in 1981, 1991 and 2001. Each group included 400 to 520 women who provided information on their height, weight, reproductive history, pattern of menstruation and menstrual pain, and contraceptive use. Five years later they were assessed again at age 24.
By comparing the same women at two different ages, the researchers said, they were able to use each woman as her own control and thereby establish whether any reduction in severity of symptoms was because of combined oral contraceptive (COC) use or increasing age.
Lindh, who is also a midwife, said: "By comparing women at different ages, it was possible to demonstrate the influence of COCs on the occurrence and severity of dysmenorrhoea, at the same time taking into account possible changes due to increasing age. We found there was a significant difference in the severity of dysmenorrhoea depending on whether or not the women used combined oral contraceptives."
Pain and other symptoms were measured by two different scales: VMS (verbal multidimensional scoring system), which grades pain as none, mild, moderate or severe, and also takes into account the effect on daily activity and whether any pain relievers were required; and VAS (visual analogue scale), with which a woman can grade her degree of pain on a 10-centimeter line that starts with "no pain at all" and ends with "unbearable pain."
"We found that combined oral contraceptive use reduced dysmenorrhoea by 0.3 units, which means that every third woman went one step down on the VMS scale — for instance from severe to moderate pain — and which meant that they suffered less pain [and] improved their working ability, and there was a decrease in the need for analgesics. On the VAS scale there was a reduction in pain of nine millimeters."
Independent of the effect of COC use, the researchers found that increasing age reduced the severity of dysmenorrhoea but not as much as COC did: It shifted women down 0.1 units on the VMS scale and five millimeters on the VAS scale. Childbirth also seemed to reduce the severity of symptoms, but that result was limited by the fact that very few women had given birth between ages 19 and 24.
The researchers also found that in the youngest group (those born in 1982), more women reported suffering from painful periods, and the severity of the symptoms was worse.
"We are unsure why this is," Lindh said. "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, in that they may be more pain sensitive or are more prepared to complain about pain than women of the same age but born earlier."
The combined oral contraceptive pill is approved for contraception by the Food and Drug Administration. The researchers said the FDA and agencies in Europe likely would require a randomized controlled trial to include dysmenorrhoea treatment as another indication for COC use, although some doctors may already prescribe it off-label to help with painful periods.
The research appeared Wednesday on the website of the journal Human Reproduction. To read a summary and access the study via subscription or purchase, visit http://bit.ly/z6foWg.
Although some previous studies and anecdotal evidence have suggested the combined oral contraceptive pill could have an impact on painful periods, a 2009 review of all available research by the Cochrane Collaboration concluded there was limited evidence for pain improvement.
The new findings by Ingela Lindh, RN, PhD, and her colleagues at Gothenburg University in Sweden show that women who used the combined oral contraceptive pill suffered less severe pain than women who did not use it.
Young women often seem to suffer more from painful periods than older women, and the researchers also found that increasing age alleviated the symptoms. But the effects of pill use and age were independent of each other, with the pill having a greater effect.
The researchers questioned three groups of women who turned 19 in 1981, 1991 and 2001. Each group included 400 to 520 women who provided information on their height, weight, reproductive history, pattern of menstruation and menstrual pain, and contraceptive use. Five years later they were assessed again at age 24.
By comparing the same women at two different ages, the researchers said, they were able to use each woman as her own control and thereby establish whether any reduction in severity of symptoms was because of combined oral contraceptive (COC) use or increasing age.
Lindh, who is also a midwife, said: "By comparing women at different ages, it was possible to demonstrate the influence of COCs on the occurrence and severity of dysmenorrhoea, at the same time taking into account possible changes due to increasing age. We found there was a significant difference in the severity of dysmenorrhoea depending on whether or not the women used combined oral contraceptives."
Pain and other symptoms were measured by two different scales: VMS (verbal multidimensional scoring system), which grades pain as none, mild, moderate or severe, and also takes into account the effect on daily activity and whether any pain relievers were required; and VAS (visual analogue scale), with which a woman can grade her degree of pain on a 10-centimeter line that starts with "no pain at all" and ends with "unbearable pain."
"We found that combined oral contraceptive use reduced dysmenorrhoea by 0.3 units, which means that every third woman went one step down on the VMS scale — for instance from severe to moderate pain — and which meant that they suffered less pain [and] improved their working ability, and there was a decrease in the need for analgesics. On the VAS scale there was a reduction in pain of nine millimeters."
Independent of the effect of COC use, the researchers found that increasing age reduced the severity of dysmenorrhoea but not as much as COC did: It shifted women down 0.1 units on the VMS scale and five millimeters on the VAS scale. Childbirth also seemed to reduce the severity of symptoms, but that result was limited by the fact that very few women had given birth between ages 19 and 24.
The researchers also found that in the youngest group (those born in 1982), more women reported suffering from painful periods, and the severity of the symptoms was worse.
"We are unsure why this is," Lindh said. "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, in that they may be more pain sensitive or are more prepared to complain about pain than women of the same age but born earlier."
The combined oral contraceptive pill is approved for contraception by the Food and Drug Administration. The researchers said the FDA and agencies in Europe likely would require a randomized controlled trial to include dysmenorrhoea treatment as another indication for COC use, although some doctors may already prescribe it off-label to help with painful periods.
The research appeared Wednesday on the website of the journal Human Reproduction. To read a summary and access the study via subscription or purchase, visit http://bit.ly/z6foWg.
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