Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review.
BACKGROUND
This article is a comprehensive overview of dysmenorrhea and a systematic review of the available literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives for the therapy and management of dysmenorrhea.


METHODS
A comprehensive search of the PubMed database for clinical trials and observational studies of dysmenorrhea treatments from 2004 onwards.


RESULTS
Eighteen publications were identified. Ten randomized controlled trials (RCTs) assessing NSAIDs for treating primary dysmenorrhea demonstrated superior pain relief compared with placebo, but no superiority was established among different NSAIDS. Two RCTs and six nonrandomized observational or prospective studies assessing the effect of hormonal contraceptives on dysmenorrhea strongly suggest a beneficial effect for dysmenorrheic pain relief and were conducted mainly in larger populations (N=41-6169) than those in the NSAID trials (N=10-337). Ethinylestradiol/chlormadinone acetate was the only formulation that provided a more pronounced relief of dysmenorrheic pain compared with a parallel alternative or previously used hormonal contraceptive. Methodological inconsistencies were widespread between the hormonal contraceptive studies.


CONCLUSIONS
The findings of this review support the use of NSAIDs as a first-line therapy for pain relief from dysmenorrhea in women without wish for contraception. For women who wish contraception, combined oral contraceptives (COCs) are the preferential therapy for pain relief from dysmenorrhea as the additional noncontraceptive benefit of pain relief from dysmenorrhea is not linked to additional risks, eliminates the risks associated with taking NSAIDs and is a more suitable long-term option. Recommendations are made to strengthen the impact of future trials through improved methodology.
Zahradnik
Hans-Peter
HP
Clinic for Endocrinology and Reproductive Medicine, University Hospital Freiburg, Freiburg, Germany. hans-peter.zahradnik@uniklinik-freiburg.de
Hanjalic-Beck
Aida
A
Groth
Klaus
K
D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D004412:Dysmenorrhea / Q000188:drug therapy*; D005260:Female; D006801:Humans
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003278:Contraceptives, Oral, Hormonal