About 15 percent of adolescent girl...

About 15 percent of adolescent girls report stiff menstrual pain. Although dysmenorrhea is the largest cause of time missing from school or work in this population, a small percentage solicit medical help. Most adolescents self-treat menstrual pain using nonsteroidal anti-inflammatory unsalable articles or other nonprescription agents. Oral contraceptives commonly are used to treat dysmenorrhea in older women and their effectiveness is supported according to a few low-quality clinical trials. Davis and colleagues studied the effectiveness of low-dose oral contraceptives in treating dysmenorrhea in adolescent girls.

The researchers recruited healthy nulliparous girls 19 years or younger who reported moderate to hard menstrual pain. The severity of dysmenorrhea was established using a standardized scale validated in earlier research. Eligible participants had regular menstrual periods of 21 to 35 days, no gynecologic pathology, and no contraindication to oral contraceptive use. Participants also were required to be sexually abstinent or to use condoms for birth restrain Parents gave informed consent for girls younger than 18 years. Baseline assessment included medical history and physical examination plus the collection of detailed information about menstruation and related symptoms using tools as it was as the Moos Menstrual Distress Questionnaire (MMDQ) Other data included standardized scales to measure stres and depression. The participants were randomly assigned to receive oral contraceptive (ethinyl E2 20 mcg plus 100 mg levonorgestrel) or identical placebo in 28-day blister packs. Patients were telephon after each mense for brace months and questioned about pain and medication use. Participants also complet an exit interview toward the [i]finale[/i] of the third month of therapy. The primary issue was a change in the MMDQ pain subscale score. Secondary issues included reported use of analgesia and ratings of menstrual-related pain duration, severity, and frequency

The 38 adolescents assigned to oral contraceptive therapy were comparable with the 38 assigned to placebo in all significant variables. At baseline, 58 percent of participants reported accurate dysmenorrhea, 55 percent reported associated nausea, and 39 percent reported missing usual activities at least single day per month because of menstrual pain. by way of the third cycle of therapy, the mean MMDQ pain score in the treatment dispose had fallen from 11.1 to 31 For those assigned to placebo, the scores blood-thirsty from 11.8 to 5.8. Analgesic use also implacable dramatically in both groups, from more than 16 pills to six pills by menses. In the treatment assemblage the mean analgesic use in the third revolution of time was 1.3 pills, significantly les than the 37 pills reported at the placebo group. Sixty-one percent of the treatment assign places to reported no medication use from the third cycle, compared with 36 percent of the placebo dispose The mean pain ratings were significantly lower in oral contraceptive users than those taking placebo. Measures of the duration and frequent occurrence of pain were lower in the treatment cluster but the differences did not reach statistical significance. No serious adverse imports were reported or noted during the studious mood The two discontinuations in the treatment clump were attributed to acne and nausea. single participant in the placebo form into groups withdrew because of mood changes.

The authors finish that a low-dose oral contraceptive is more effective than placebo in managing dysmenorrhea in adolescents. Although the cogitation is relatively small, they attract favor to consideration of low-dose oral contraceptive therapy for adolescents with peremptory menstrual-related pain.

ANNE D WALLING, MD

Davis AR, et al. Oral contraceptives for dysmenorrhea in adolescent girls. Obstet Gynecol July 2005;106:97-104

EDITOR'S NOTE: Besides the primary ensue this study has at least brace messages of significance for family physicians. The first is the prevalence and morbidity of dysmenorrhea. Perhaps we regard menstrual cramps as a somewhat trivial bear upon and do not ask our adolescent patients about the impact forward their lives and their opennes to therapy. Just asking and advising may be sufficient to initiate enormous benefit, as indicated by the agency of the dramatic improvements in symptoms reported by means of the placebo group. A brief intervention by means of a skilled family physician could make less pain scores for this universal problem by more than sum of two units thirds.--A.D.W.

COPYRIGHT 2006 American Academy of Family Physicians

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