What is the role of combination therapies in the treatment of dysmenorrhea?

Updated: Sep 23, 2019
  • Author: Karim Anton Calis, PharmD, MPH, FASHP, FCCP; Chief Editor: Michel E Rivlin, MD  more...
  • Print

Combination OCs, the levonorgestrel intrauterine device, and depot medroxyprogesterone acetate [67] provide effective pain relief and are associated with reduced menstrual flow. It may be necessary to add an NSAID to the OC, especially during the first few cycles after initiation of the OC. The ethinyl estradiol dose should generally be less than 50 µg; a monophasic OC containing 30 µg is a reasonable choice. To date, studies comparing the efficacy of various OC formulations in the management of dysmenorrhea have not been performed.

In a study of women with primary dysmenorrhea, Petraglia et al found that estradiol valerate plus dienogest and ethinyl estradiol plus levonorgestrel were comparably effective in relieving dysmenorrheic pain. Each of the treatments was taken orally by over 200 women daily for three 28-day cycles, with the number of days of pain and the degree of pain being evaluated. Based on the patients’ self-assessments, the investigators determined that pain was reduced by both treatments by approximately the same number of days (by 4.6 days for estradiol valerate plus dienogest, by 4.2 days for ethinyl estradiol plus levonorgestrel). [68]

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!