title: Effects of over-the-counter analgesic use on reproductive hormones and ovulation in healthy, premenopausal women.
abstract: OBJECTIVE
  Does use of commonly used over-the-counter (OTC) pain medication affect reproductive hormones and ovulatory function in premenopausal women?
  
  
  CONCLUSIONS
  Few associations were found between analgesic medication use and reproductive hormones, but use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for potential confounders.
  
  
  BACKGROUND
  Analgesic medications are the most commonly used OTC drugs among women, but their potential effects on reproductive function are unclear.
  
  
  METHODS
  The BioCycle Study was a prospective, observational cohort study (2005-2007) which followed 259 women for one (n = 9) or two (n = 250) menstrual cycles.
  
  
  METHODS
  Two hundred and fifty-nine healthy, premenopausal women not using hormonal contraception and living in western New York state. Study visits took place at the University at Buffalo.
  
  
  RESULTS
  During study participation, 68% (n = 175) of women indicated OTC analgesic use. Among users, 45% used ibuprofen, 33% acetaminophen, 10% aspirin and 10% naproxen. Analgesic use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for age, race, body mass index, perceived stress level and alcohol consumption (OR 0.36 [0.17, 0.75]). Results remained unchanged after controlling for potential confounding by indication by adjusting for 'healthy' cycle indicators such as amount of blood loss and menstrual pain during the preceding menstruation. Moreover, luteal progesterone was higher (% difference = 14.0, -1.6-32.1, P = 0.08 adjusted) in cycles with follicular phase analgesic use, but no associations were observed with estradiol, LH or FSH.
  
  
  CONCLUSIONS
  Self-report daily diaries are not validated measures of medication usage, which could lead to some classification error of medication use. We were also limited in our evaluation of aspirin and naproxen which were used by few women.
  
  
  CONCLUSIONS
  The observed associations between follicular phase analgesic use and higher progesterone and a lower probability of sporadic anovulation indicate that OTC pain medication use is likely not harmful to reproduction function, and certain medications possibly improve ovulatory function.
  
  
  BACKGROUND
  This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract # HHSN275200403394C). The authors have no conflicts of interest to disclose.
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Matyas
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Mumford
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Schliep
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Ahrens
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Sjaarda
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Perkins
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Filiberto
authors.affiliation: Risk Sciences International and University of Ottawa, Ottawa, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Mattison
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Zarek
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wactawski-Wende
authors.affiliation: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA schistee@mail.nih.gov.
authors.forename: E F
authors.initials: EF
authors.lastname: Schisterman
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000494:pharmacology*; D000858:Anovulation / Q000517:prevention & control; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D005498:Follicular Phase / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects / Q000494:pharmacology; D009288:Naproxen / Q000009:adverse effects / Q000494:pharmacology; D009518:New York; D010060:Ovulation / Q000187:drug effects*; D017697:Premenopause / Q000187:drug effects*; D011374:Progesterone / Q000097:blood*; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D011374:Progesterone; D009288:Naproxen; D001241:Aspirin; D007052:Ibuprofen
keywords: analgesics; over-the-counter drugs; ovulation; reproductive hormones