Combined Hormonal Contraception in the Treatment of Dysmenorrhea

Dysmenorrhea and Hormonal Therapy

Dysmenorrhea can be quite uncomfortable, and many gynecological patients complain about it in clinics. Its prevalence among menstruating women ranges from 50–90%. Menstrual pain, along with other symptoms associated with dysmenorrhea, can significantly negatively impact the quality of life of women—affecting even their work performance. Therefore, it is very important for patients suffering from dysmenorrhea to have access to effective therapy that alleviates the pain.

Previous studies have shown that various types of combined hormonal contraception effectively reduce menstrual pain in primary dysmenorrhea and pain associated with endometriosis by 75–90%. Low-dose oral hormonal contraception combining 3 mg drospirenone and 0.02 mg ethinylestradiol has proven contraceptive effects, is safe, its effect is reversible, and it has several other advantages, including alleviating symptoms of dysmenorrhea. The administration regimen is “24+4,” where women continuously take the active ingredients for 24 days, followed by 4 days of placebo.

To evaluate the effectiveness of hormonal contraception combining drospirenone and ethinylestradiol in the treatment of dysmenorrhea, an analysis of a clinical study published in 2021 was conducted.

Evaluated Patient Population and Analysis Goals

An open-label multicenter single-arm interventional post-authorization analysis of a clinical study examined the effectiveness and safety of oral hormonal contraception containing drospirenone and ethinylestradiol in the treatment of dysmenorrhea over 6 cycles of therapy. The analysis included 526 patients suffering from dysmenorrhea.

The primary goal was to record changes in the intensity of menstrual pain, assessed using a visual analog scale of pain (VAS; measured from 0–100 mm). Patients reported the pain intensity before starting the tablets and during 4 check-ups over 6 cycles of contraception use. Secondary goals included recording unwanted pregnancies, monitoring the course of bleeding, the cycle, and treatment safety. 

Findings

When using tablets containing drospirenone and ethinylestradiol, the intensity of menstrual pain assessed by VAS significantly decreased. Compared to baseline values of 49.5 ± 23.7 mm, at the 2nd check-up it was 32.3 ± 24.9 mm, at the 3rd check-up 20.7 ± 19.4 mm, and at the 4th check-up 18.4 ± 18.7 mm (p < 0.01).

Between the 2nd and 5th cycle of treatment, the occurrence of regular withdrawal bleeding in women increased from 93.9% (450/479) to 96.4% (431/447), and the duration of withdrawal bleeding decreased from 5.7 (± 2.7) to 5.4 (± 1.8) days. Additionally, the occurrence of intermenstrual bleeding decreased from 9.0% (43/479) to 5.6% (25/447).

Adverse events were reported by 17.5% of patients, most commonly breast pain, nausea, breast swelling, headache, and uterine bleeding. No thromboembolic events or patient deaths were recorded during the study. 

Summary and Conclusion

According to the results of the cited study, oral hormonal contraception combining drospirenone and ethinylestradiol is effective in the treatment of dysmenorrhea. During 6 cycles of tablet use, there was a significant reduction in the intensity of menstrual pain. The longer the contraception was used, the more significant the pain alleviation. According to the analysis results, the duration of withdrawal bleeding and the occurrence of intermenstrual bleeding decreased during tablet use. The safety assessment also yielded positive results.

(vef)

Source: Li X. Y., Quian F. B., He Y. J. et al. Clinical observation of combined oral contraceptives drospirenone and ethinylestradiol tablets (Ⅱ) in the treatment of dysmenorrhea in Chinese women. Zhonghua Fu Chan Ke Za Zhi 2021 Oct 25; 56 (10): 684–690, doi: 10.3760/cma.j.cn112141-20210719-00385.