Clinical question
What are the benefits and harms of combined oral contraceptive pills (OCPs) for the management of primary dysmenorrhoea?
Bottom line
OCPs are more effective than placebo at treating dysmenorrhoea (painful menstrual cramps). However, they have adverse effects in the form of irregular bleeding, headache and nausea.
Continuous use of OCPs without pause, compared with the standard 21-day treatment/ seven-day pause regimen, may be superior at treating dysmenorrhoea.
There were no differences found between the different OCPs, and there was insufficient evidence to estimate the effects of NSAIDs compared with OCPs.
Caveat
This review did not cover long-term adverse effects (over 6 months) due to lack of long-term randomised controlled trials.
No more studies comparing OCPs with placebo for dysmenorrhoea are needed, but long-term studies ensuring the safety of continuous usage of OCP (ie, without a pause) are needed. Comparisons with other standard medical treatments would also be useful.
Prescribers need to consider that the use of OCPs as treatment for dysmenorrhoea does not just depend on efficacy, but also on the suitability of the treatment for each woman. If a woman wants to become pregnant or has contraindications to the OCP, then the OCP would be an unsuitable treatment option at that time.
Context
Dysmenorrhoea is common and a major cause of pain in women. OCPs are often used in the management of primary dysmenorrhoea, but there is a need for reviews reporting the benefits and harms. Primary dysmenorrhoea is defined as painful menstrual cramps without pelvic pathology.
Cochrane Systematic Review
Schroll JB, et al. Combined oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2023;7:CD002120. This review contains 21 trials with a total of 3723 participants.
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