title: The effect of pycnogenol on patients with dysmenorrhea using low-dose oral contraceptives.
abstract: OBJECTIVE
  Menstrual symptoms such as dysmenorrhea usually occur during the hormone-free interval in oral contraceptive users. Progestin withdrawal activates NF-κB transcription factor, which upregulates both vascular endothelial growth factor (VEGF) and Cox-2 expression in the endometrium. The use of natural NF-κB inhibitors such as pycnogenol may block this response, improving dysmenorrhea.
  
  
  METHODS
  Twenty-four patients with severe dysmenorrhea were allocated to one of two treatment groups. In Group A (n=13), women were treated with an oral contraceptive containing 15 μg of ethinyl estradiol and 60 mg of gestodene (Adoless(®)) in a 24/4 regimen for three consecutive cycles. Women in Group B (n=11) used the same contraceptive regimen together with 100 mg of pycnogenol (Flebon(®)) continuously for 3 months. Pain scores were graded using a visual analog scale (VAS) before and during the hormone-free interval at the end of the third treatment cycle.
  
  
  RESULTS
  Before treatment, VAS pain scores for dysmenorrhea were 8 and 9 in Groups A and B, respectively. However, by the end of the third treatment cycle, pain scores had decreased significantly (P<0.05) both in groups A and B. The final pain scores were 6 in Group A and 2 in Group B, a difference that was statistically significant (P<0.0001). In Group B, 27% of the patients became pain-free, while in Group A, none of the women reported complete disappearance of this symptom. The number of bleeding days was also lower in Group B.
  
  
  CONCLUSIONS
  Pycnogenol effectively decreased pain scores and the number of bleeding days when administered concomitantly with a low-dose 24/4 oral contraceptive containing gestodene.
authors.affiliation: Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), Salvador, Bahia, Brazil.
authors.forename: Hugo
authors.initials: H
authors.lastname: Maia
authors.affiliation: Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), Salvador, Bahia, Brazil.
authors.forename: Clarice
authors.initials: C
authors.lastname: Haddad
authors.affiliation: Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), Salvador, Bahia, Brazil.
authors.forename: Julio
authors.initials: J
authors.lastname: Casoy
keywords: gestodene; hormone-free interval; pain