Clinical Question

Are combined oral contraceptives safe and effective for the management of primary dysmenorrhea?

Evidence-Based Answer

Combined oral contraceptives reduce pain associated with primary dysmenorrhea compared with placebo (standardized mean difference [SMD] = −0.58; 95% CI, −0.74 to −0.41). (Strength of Recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.) Oral contraceptives increase the risk of any adverse effects when compared with placebo (number needed to harm [NNH] = 5; 95% CI, 4 to 8; SOR: A, based on consistent, good-quality patient-oriented evidence), although the risk of serious adverse events is unclear due to few events.¹

Practice Pointers

Dysmenorrhea is recurrent cramping and lower abdominal pain associated with menses. Up to 50% to 90% of reproductive-aged women meet the criteria for dysmenorrhea in their lifetime, and approximately one-half miss work or school at least once due to symptoms.² Primary dysmenorrhea occurs in the absence of underlying pathology. The authors of this Cochrane review sought to determine the benefits and harms of combined oral contraceptives in the treatment of primary dysmenorrhea.