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Effect of ‘The Pill’ on Menstrual Pain Confirmed – Young women with dysmenorrhea experience less severe symptoms if they take combined oral contraceptives, a Swedish longitudinal study confirmed.

On a verbal multidimensional scoring (VMS) system that rated pain as none, mild, moderate, or severe, women using these contraceptives had a mean reduction of 0.3 units (P<0.0001), meaning that one in three moved down one category on the scale, according to Ingela Lindh, PhD, and colleagues from Gothenburg University in Gothenburg.

In addition, on a 10-cm visual analog scale (VAS), oral contraceptive use was associated with a 9-mm decrease (P<0.0001) in symptom severity, the researchers reported online in Human Reproduction.

Combined oral contraceptives have long been used off-label for dysmenorrhea, but a Cochrane review found only limited evidence for efficacy.

To explore the effects of these agents on the many young women troubled by dysmenorrhea, Lindh and colleagues analyzed data from a longitudinal study initiated in 1981.

The study included three cohorts, each comprising 400 to 520 women, who were born in 1962, 1972, and 1982 and who were 19 years of age at the time of enrollment.

The women were then seen again five years later, at age 24.

At both time points, they completed a questionnaire on contraceptive use, severity of symptoms, effects on daily activities, absenteeism, and analgesic use.

Compared with the 1962 cohort, higher VMS severity scores were reported by the 1982 cohort at both ages 19 and 24 (P<0.05; P<0.001).

Severity also was greater on VAS scores for the 1982 cohort compared with the 1962 and 1972 cohorts at ages 19 and 24 (P<0.001; P<0.01).

Almost one-third of women in all three cohorts reported absenteeism because of dysmenorrhea at age 19, which fell to less than one-quarter by age 24.

The researchers then performed a case-control analysis, in which each woman served as her own control. They compared symptoms in women who were not using combined oral contraceptives at age 19 but were doing so at age 24, and vice versa.

They found consistent benefits for contraceptive use.

For instance, VMS scores in the 1962 cohort on contraceptives at 19 increased from 1.39 to 1.58 at the later time point if they were no longer users, for a treatment difference of 0.18 (95% CI ?0.12 to 0.48).

In contrast, scores in that cohort fell from a mean of 1.32 in those not taking oral contraceptives at 19 to a mean of 0.75 if they subsequently began contraceptive users, for a difference of ?0.57 (95% CI ?0.81 to ?0.33).

Similar results were seen on VMS scores for the 1972 and 1982 cohorts and for all study participants, with these total treatment benefits for oral contraceptive use:

* 1972, 0.51 (95% CI 0.07 to 0.95, P<0.05)
* 1982, 0.33 (95% CI ?0.03 to 0.68)
* All, 0.58 (95% CI 0.35 to 0.81, P<0.0001)

Visual analog scores also showed consistent improvements, with total treatment benefits ranging from 13.8 (P<0.05) to 24.7 (P<0.001).

Increasing age also was associated with decreased severity of symptoms, with a decreased VMS score of 0.1 units over five years, but the effects of contraceptive use were independent of age.

An additional factor that influenced dysmenorrhea severity — but to a lesser degree than oral contraceptives — was childbirth, and there were too few births for this factor to be fully analyzed.

“It is desirable that the findings from this study providing evidence for a beneficial effect of [combined oral contraceptives] in dysmenorrhea be confirmed by a placebo-controlled, randomized trial where the efficacy of [combined oral contraceptives] in dysmenorrhea is assessed as a primary outcome measure,” Lindt and colleagues stated.

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