Saturday, August 20, 2005

Painful Periods and Adolescents

Painful periods: most women have the pleasure, and most women could do without this experience.

Adolescents, in particular, are affected by, and have to deal with, this problem[dysmenorrhea=painful period; OC=oral contraceptive, the combination Pill]:

Primary dysmenorrhea, defined as painful menstruation in the absence of organic pathology, is prevalent during adolescence and may affect as many as 15% (2 million) of U.S. females age 13 to 19 years.... Fourteen percent of U.S. adolescents with dysmenorrhea, including only 29% of those with severe dysmenorrhea, seek physician help. OCs and nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for dysmenorrhea in women, but there are few studies targeting adolescents with this problem.... There is evidence for the efficacy of OCs for controlling dysmenorrhea in adults, but the studies mainly focus on high-dose OCs. One study showed that in adolescent females, adherence to OC regimens in those taking OCs for contraception was eight times higher if there was a reduction in dysmenorrhea....

A small study of women 19 years or younger reporting moderate or severe painful periods looked at the effect using a low-dose OCP (20 μg of estrogen and 100 μg of progestin) for three months. The findings:

  • 58% had severe and 42% had moderate dysmenorrhea at baseline. 55% reported nausea; 24%, vomiting; and 5%, syncope. 39% reported missing 1 school day monthly and 14% missed 2 school days monthly because of dysmenorrhea.

  • By the third cycle, OC users rated their worst pain as less (mean rating, 3.7 vs 5.4; P = .02) and took less pain medication (mean pills taken, 1.3 vs 3.7; P = .05) than did placebo users.

  • 61% of OC users vs 36% of placebo users reported taking no medications for pain during cycle 3 (OR, 0.37; 95% CI, 0.14 - 1.0).

  • Treatment effects were similar between older and younger participants, among the different ethnic groups, and between those with moderate vs severe dysmenorrhea.

  • Ratings of worst pain decreased in both groups over time (P = .001).

  • OC users also reported fewer days of any pain, fewer days of severe pain, and fewer hours of pain on the worst pain day than did placebo users, but these differences were not statistically significant.

  • Days of missed school could not be assessed because of erratic schedules of participants.

    The conclusion:

    "Among adolescents, a low-dose oral contraceptive relieved dysmenorrhea-associated pain more effectively than placebo," the authors write.


    "The results of this unique randomized trial support the use of low-dose OCs for the treatment of dysmenorrhea in adolescent girls," the authors write. "OCs should become an important treatment option for the millions of adolescents who experience high morbidity from dysmenorrhea and are currently undertreated."


    At 3:30 PM, Anonymous Anonymous said...

    That's good to know, though I guess there's be a lot of opposition to younger girls being prescribed OCPs, out of fears of "encouraging them to have sex" or whatever.

    I imagine extended cycle regimes would also be a good idea?

    I was also surprised to see the article mention "as many as 15%" of girls suffering dysmenorrhea, as though that was a surprisingly high figure. Because to me it seems quite low; I would have thought most girls/women suffer painful periods to some extent, even if severe pain is more rare.


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