Primary dysmenorrhea is the most common cause

Continuous Compared With Cyclic Oral Contraceptives for the Treatment of Primary Dysmenorrhea A Randomized Controlled Trial Romana Dmitrovic, MD, PhD...
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Continuous Compared With Cyclic Oral Contraceptives for the Treatment of Primary Dysmenorrhea A Randomized Controlled Trial Romana Dmitrovic,

MD, PhD,

Allen R. Kunselman,

From the BetaPlus Center for Reproductive Medicine, Zagreb, Croatia; and the Departments of Obstetrics and Gynecology and Public Health Sciences, Penn State University College of Medicine, Hershey Medical Center, Hershey, Pennsylvania. Supported by the National Institutes of Health grants RO3 TW007438 and K24 HD01476. The authors thank Martina Slisuric and Ivana Segedin from Nova Gradiska General Hospital for supervising this study, and Christina Stetter from the Department of Public Health Sciences Penn State College of Medicine for statistical programming support. Presented as an oral presentation at the 67th Annual Meeting of the American Society for Reproductive Medicine, October 15–18, 2011, Orlando, Florida. Corresponding author: Romana Dmitrovic, BetaPlus Center for Reproductive Medicine, Av. V. Holjevca 23, 10000 Zagreb, Croatia; e-mail: [email protected] Financial Disclosure Allen Kunselman owns stock in Merck & Co. Dr. Legro has received the following: 1) travel reimbursement from the British Fertility Society, The Association for Clinical Embryologists & Society for Reproductive & Fertility, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, The Israel Fertility Society, American Society of Reproductive Medicine, University of Michigan, Weill Cornell Medical College, Reproductive Medicine Network, American Board of Obstetrics & Gynecology, Taiwan Society of Reproductive Medicine, Northwestern University, Specialized Cooperative Centers Program in Reproductive & Infertility Research, The Endocrine Society, V Conference Gynaecological Endocrinology, European Society of Human Reproduction & Embryology, Virginia Commonwealth University, Einstein Medical School, University of Sao Paulo, Southwestern Medical Center, National Institutes of Health (STEP), and the National Institutes of Health Federal Drug Administration (Adelphi, MD); 2) honoraria for lectures from the Taiwan Society of Reproductive Medicine, Northwestern University, and Southwestern Medical Center; 3) honoraria for consulting from American Society of Reproductive Medicine, National Institute of Health, American Board of Obstetrics and Gynecology, National Institutes of Health Office of Extramural Research STEP Program, and National Institutes of Health Federal Drug Administration; 4) travel reimbursement from the University of Pennsylvania Medicine, University of Vermont College of Medicine, and European Society of Human Reproduction and Embryology; 5) honoraria for lectures from the University of Vermont College of Medicine; and 6) honoraria for consulting from Deutsche Bank Securities Inc. The other author did not report any potential conflicts of interest. © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/12

VOL. 119, NO. 6, JUNE 2012

MA,

and Richard S. Legro,

MD

OBJECTIVE: To estimate whether continuous oral contraceptive pills (OCPs) will result in more pain relief in primary dysmenorrhea patients than cyclic OCPs, which induce withdrawal bleeding with associated pain and symptoms. METHODS: We conducted a double-blind, randomized, controlled trial comparing continuous to a cyclic 21–7 OCP regimen (gestodene 0.075 mg and ethinyl estradiol 20 microgram) for 6 months in 38 primary dysmenorrhea patients. The primary outcome was the difference in subjective perception of pain as measured by the visual analog scale over a period of 6 months. RESULTS: Twenty-nine patients completed the study. In both groups, pain reduction measured by visual analog scale declined over time and was significant at 6 months compared with baseline, with no difference between groups. Continuous regimen was superior to cyclic regimen after 1 month (mean difference ⴚ27.3, 95% confidence interval [CI] ⴚ40.5 to ⴚ14.2; P

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