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Meta-Analysis
. 2009 Oct 7;2009(4):CD002120.
doi: 10.1002/14651858.CD002120.pub3.

Oral contraceptive pill for primary dysmenorrhoea

Chooi L Wong  1 , Cindy Farquhar, Helen Roberts, Michelle Proctor
Affiliations
Meta-Analysis

Oral contraceptive pill for primary dysmenorrhoea

Chooi L Wong et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Dysmenorrhoea (painful menstrual cramps) is common. Combined OCPs are recommended in the management of primary dysmenorrhoea.

Objectives: To determine the effectiveness and safety of combined oral contraceptive pills for the management of primary dysmenorrhoea.

Search strategy: We conducted electronic searches for randomised controlled trials (RCTs) in the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials CENTRAL, CCTR, MEDLINE, EMBASE, and CINAHL (first conducted in 2001, updated on 5 November 2008).

Selection criteria: RCTs comparing all combined OCPs with other combined OCPs, placebo, no management, or management with nonsteroidal anti-inflammatories (NSAIDs) were considered.

Data collection and analysis: Twenty three studies were identified and ten were included. Six compared the combined OCP with placebo and four compared different dosages of combined OCP.

Main results: One study of low dose oestrogen and four studies of medium dose oestrogen combined OCPs compared with placebo, for a combined total of 497 women, reported pain improvement. For the outcome of pain relief across the different OCPs the pooled OR suggested benefit with OCPs compared to placebo (7 RCTs: Peto OR 2.01 [95% CI 1.32, 3.08]).The Chi-squared test for heterogeneity showed there is significant heterogeneity with an I(2) statistic of 64% and a significant chi-square test (14.06, df=5, p=0.02). A sensitivity analysis removing the studies with inadequate allocation concealment suggested significant benefit of treatment with the pooled OR of 2.99 (95% CI 1.76, 5.07) and heterogeneity no longer statistically significant and I(2) statistic of 0%.Three studies reported adverse effects (Davis 2005; Hendrix 2002; GPRG 1968) The adverse effects were nausea, headaches and weight gain. Two studies reported if women experienced any side effect and no evidence of an effect was found (3 RCTs: OR = 1.45 (95% 0.71, 2.94). There was no evidence of statistical heterogeneity.There were no studies identified that compared combined OCP versus non steroidal anti-inflammatory drugsThere was no evidence of a difference for the pooled studies for 3rd generation pro gestagens (OR = 1.11 (95% CI 0.79 - 1.57)). For the 2nd generation versus 3rd generation the OR was 0.44 (95% CI 0.23-0.84) suggesting benefit of the 3rd generation OCP but this was for a single study (Winkler 2003).

Authors' conclusions: There is limited evidence for pain improvement with the use of the OCP (both low and medium dose oestrogen) in women with dysmenorrhoea. There is no evidence of a difference between different OCP preparations.

PubMed Disclaimer

Conflict of interest statement

Helen Roberts has received funding from Schering, Wyeth, Pharmaco Organanon, and Pharmacia Upjohn in the past.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.1 Pain improvement.
4
4
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.2 Pain score (mean change).
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5
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.3 Additional analgesia required.
6
6
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.4 Absence from school or work.
7
7
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.5 Withdrawals from treatment.
8
8
Forest plot of comparison: 1 Combined OCP versus placebo or no treatment, outcome: 1.6 Adverse events.
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9
Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.1 Pain improvement.
10
10
Forest plot of comparison: 2 Combined low dose OCP versus Combined low doseOCP, outcome: 2.2 Withdrawals from treatment.
1.1
1.1. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 1 Pain improvement.
1.2
1.2. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 2 Pain score (mean change).
1.3
1.3. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 3 Additional analgesia required.
1.4
1.4. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 4 Absence from school or work.
1.5
1.5. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 5 Withdrawals from treatment.
1.6
1.6. Analysis
Comparison 1 Combined OCP versus placebo or no treatment, Outcome 6 Adverse events.
2.1
2.1. Analysis
Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 1 Pain improvement.
2.2
2.2. Analysis
Comparison 2 Combined low dose OCP versus Combined low doseOCP, Outcome 2 Withdrawals from treatment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bassol 2000 {published data only}
    1. Bassol S, Alvarado A, Celis C, Cravioto MC, Peralta O, Montano R, et al. Latin American experience with two low‐dose oral contraceptives containing 30µg ethinylestradiol/75µg gestodene and 20µg ethinyl estradiol/150µg desogestrel. Contraception 2000;62(3):131‐5. - PubMed
Buttram 1969a {published data only}
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Buttram 1969b {published data only}
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Cullberg 1972 {published data only}
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Hendrix 2002 {published data only}
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Nakano 1971 {published data only}
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Serfaty 1998 {published data only}
    1. Serfaty D, Vree ML. A comparison of the cycle control and tolerability of two ultra low‐dose oral contraceptives containing 20µg ethinyl estradiol and either 150µg desogestrel and 75µg gestodene. The European Journal of Contraception and Reproductive Health Care 1998;3(4):179‐89. - PubMed
Winkler 2003 {published and unpublished data}
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References to studies excluded from this review

Creatsas 1998 {published data only}
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Foidart 2000 {published data only}
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Kremser 1971 {published data only}
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Kristjansdottir 2000 {published data only}
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Kwiecien 2003 {published data only}
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La Guardia 2003 {published data only}
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Moore 1999 {published data only}
    1. Moore C, Feichtinger W, Klinger G, Melliger U, Spona J, Walter F, Winkler UH, Zahradnik HP. Clinical findings with the dienogest‐containing oral contraceptive Valette(TM). Drugs of Today 1999;35(Suppl. C):53‐68.
Reisman 1999 {published data only}
    1. Reisman H, Deborah M, Gast MJ. A multicenter randomized comparison of cycle control and laboratory findings with oral contraceptive agents containing 100µg levonorgestrel with 20µg ethinyl estradiol or triphasic norethindrone with ethinyl estradiol. American Journal of Obstetrics & Gynecology 1999;181(5 part 2):S45‐S52. - PubMed
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Additional references

Brill 1991
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Chan 1981
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References to other published versions of this review

Proctor 2001
    1. Proctor ML, Roberts H, Farquhar CM. Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858] - DOI - PubMed

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