A three decade long study has proven that oral contraceptive pills may alleviate painful periods for some women. Estimates suggest more than half of women have suffered from the condition, called dysmenorrhea, at some point.
The Scandinavian study, reported in the journal Human Reproduction, found women on the pill reported slightly less severe period pains. Oral contraceptives are not currently officially licensed for this purpose.
The researchers, from Sahlgrenska Academy at Gothenburg University, followed groups of hundreds of 19-year-olds, recruiting some in 1981, some in 1991, and the rest in 2001. Five years after an initial health questionnaire, the women were contacted again to see if anything had changed.
Dr Ingela Lindh, who led the study, said, “We found there was a significant difference in the severity of dysmenorrhea depending on whether or not the women used combined oral contraceptives.” While it was hard to quantify precisely this difference in pain levels, on average it represented a change from “severe” to “moderate” pain in every third woman in the group taking oral contraceptives.
“By comparing women at different ages, it was possible to demonstrate the influence of [combined oral contraception] on the occurrence and severity of dysmenorrhea, at the same time taking into account possible changes due to increasing age,” Lindh said in a statement. “We found there was a significant difference in the severity of dysmenorrhea depending on whether or not the women used combined oral contraceptives.”
Dr Lindh said that the impact of painful periods should not be underestimated. One US survey suggested that the condition could cause 600m lost working hours in the US each year. She said, “Painful periods occur frequently, particularly in young women where as many as 50% to 75% suffer from dysmenorrhea. It can have a detrimental effect on these women's lives, causing regular absenteeism from school and work, and interfering with their daily activities for several days each month. Effective management of dysmenorrhea is beneficial for both the women affected and society.”
However, earlier efforts to detect any link between the pill and period pain had proved fruitless, with a 2009 Cochrane Review concluding there was limited evidence for pain improvement. At present, the European Medicines Agency, which oversees drug licensing across the EU, does not include the treatment of period pain as a licensed use for oral contraceptives. This means that any doctor in the UK who wishes to prescribe for that purpose would have to go outside the official licensing scheme, and many would be unwilling to do so. “Gynecologists have been prescribing combined oral contraceptives for the last 40 years and for this indication,” said Dr. Paula Hillard, professor of obstetrics and gynecology at Stanford University School of Medicine. “It was disappointing to see results of Cochrane. ... But gynecologists didn't feel that this proved that the pills weren't helpful, only that the studies hadn't yet been done to show it.”
Dr Lindh said that the new information from her study should be included in contraceptive counseling sessions.
Sheila Tyne, a nurse advisor at Women's Health Concern, said that as many as 10% of women suffered severe and debilitating period pain each month. She said, “Some GPs are prepared to prescribe the contraceptive pill for this reason - it certainly doesn't help everyone, but there are a lot of women who say that taking the pill has made things better. It's something we would talk about to women as part of a consultation on contraception, although we are not allowed to prescribe oral contraceptives for period pain alone.”
“This is a well-done, informative study,” said Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at the University of Missouri-Kansas City. “The evidence is finally available to support what physicians see in their offices on a daily basis - women with painful menses are indeed helped by being on a combined estrogen/progesterone pill to make the menses lighter and less painful in discharge.”
The study was funded by the Gothenburg Medical Society, the Hjalmar Svenssons Fund and a Swedish government grant.
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