Intervention Review

Oral contraceptive pill for primary dysmenorrhoea

  1. Chooi L Wong1,*,
  2. Cindy Farquhar2,
  3. Helen Roberts3,
  4. Michelle Proctor4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 17 FEB 2008

DOI: 10.1002/14651858.CD002120.pub3


How to Cite

Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD002120. DOI: 10.1002/14651858.CD002120.pub3.

Author Information

  1. 1

    FMHS, O & G, Auckland, New Zealand

  2. 2

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  3. 3

    Faculty of Medicine and Health Sciences University of Auckland, Obstetrics & Gynaecology, Auckland, New Zealand

  4. 4

    Department of Corrections, Psychological Service, Auckland, New Zealand

*Chooi L Wong, O & G, FMHS, Auckland, New Zealand. cwon164@ec.auckland.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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 I2 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 I2 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 drugs

There 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea

Dysmenorrhoea is painful menstruation (woman's monthly bleeding) with the symptoms including cramping, headaches, nausea and vomiting. An excess of the hormone prostaglandin is a known cause. The synthetic hormones in combined oral contraceptive pills suppress ovulation, which could result in a reduction in dysmenorrhoea. The OCP reduces the amount of prostaglandin produced by glands in the lining of the uterus; which then reduces both uterine blood flow and cramps. The preparations of OCP with doses less than 35 mcg were effective and should be the preparation of choice.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以口服避孕藥來當作原發性經痛的治療方式

經痛(劇痛的月經性抽搐)是很常見的。在處理原發性的經痛時,醫師們會推薦使用組合型的口服避孕藥(OCPs)。

目標

針對處理原發性的經痛而言,要確認組合型的口服避孕藥之功效與安全性。

搜尋策略

以電腦搜尋以找出Cochrane Menstrual Disorders以及Subfertility Group Register of controlled trials CENTRAL、CCTR、 MEDLINE、EMBASE,以及 CINAHL (第一次搜尋的時間是2001年,並於2008年11月5日更新) 當中的隨機對照試驗 (RCT) 。

選擇標準

只要是比較組合型的口服避孕藥與其他組合型的口服避孕藥、安慰劑、不採取處理,或是以非類固醇類的抗發炎藥物(NSAIDs)的隨機對照試驗,都會被列入考慮。

資料收集與分析

當中共確認了23份研究,並且收集了10份。有6份將組合型的口服避孕藥與安慰劑之間進行了比較,而有4份則是將組合型之口服避孕藥的不同劑量之間進行了比較。

主要結論

有1份研究是低劑量的雌激素,而有4份研究是中等劑量的雌激素口服避孕藥,比較的對象則是安慰劑,合起來總共有497名婦女,其中她們都指出疼痛的部分有獲得改善。透過不同的口服避孕藥加上混合後的勝算比,對於紓解疼痛的結果來說,跟安慰劑比較起來,口服避孕藥可以帶來幫助(7份隨機對照試驗:Peto OR 2.01【95% CI 1.32,3.08】)。針對異質性所作的Chisquared測試顯示,當中會有明顯的異質性,而且I2 statistic 的結果為64% ,並且有顯著的 chisquare測試(14.06,df = 5,p = 0.02)。在1份靈敏度的分析當中,去除了內文中隱瞞了不適當之分配狀況的研究,而這份分析認為,治療有明顯的益處但其勝算比為2.99 (95% CI 1.76,5.07) ,而且質異性也不再具有統計學上的顯著性,同時I2 statistic的結果為0% 。共有3份研究曾經針對副作用提出過報告(Davis 2005;Hendrix 2002;GPRG 1968)。這些副作用為噁心、頭痛,以及體重增加。關於婦女們是否曾經遇到過任何的副作用,有2份研究曾經報告過,並且從中並沒有發現到任何有關於影響的證據(3 RCTs:OR = 1.45(95% 0.71,2.94))。關於統計學上的異質性方面,則沒有任何證據。針對組合型的口服避孕藥與非類固醇類的抗發炎藥物比較起來,並沒有發現到任何研究曾經加以比較。對於第3代的孕酮類藥物(progestagens)而言,在所有的研究當中,並沒有證據能夠指出任何的差異存在(OR = 1.11(95% CI 0.79 – 1.57))。關於第2代與第3代之間的比較,OR的值為0.44(95% CI 0.23 – 0.84),因此我們認為第3代的口服避孕藥具有優勢,但是這只是針對單1份研究而已(Winkler 2003)。

作者結論

對於身受經痛所苦的婦女們而言,若是想要使用口服避孕藥(包括低劑量與中劑量的雌激素)來改善疼痛狀況,並沒有足夠的證據可以支持。在不同的口服避孕藥製程之間,並沒有證據顯示會有任何的差異存在。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

對於原發性的經痛而言,組合型的口服避孕藥(低劑量與中劑量)是有效的。經痛是令人感到疼痛的經期出血(女性每個月的出血現象),並且帶有許多的症狀,包括了痙攣、頭痛、噁心,以及嘔吐。目前已經知道其中之ㄧ的原因便是,體內有過多的荷爾蒙前列腺素。口服合成型的荷爾蒙避孕藥,可以抑制排卵的發生,這樣就可能會減少經痛的困擾。口服的避孕藥可以降低子宮內側之腺體所產生的前列腺素含量;然後,這樣的條件就可以減少子宮內的血液流量,並且降低痙攣的現象。以低於35 mcg 劑量的口服避孕藥來進行治療是有效的,且應是選擇之ㄧ。