A Cochrane review 1 [Abstract] included 5 trials, of which 3 trials including a total of 404 subjects provided data for analysis. Compared with placebo, combined oral contraceptives (COC) improved self-reported pain: in dysmenorrhoea verbal rating scale (scale 0 to 3) mean difference (MD) -1.30 points, 95% CI -1.84 to -0.76; 1 RCT, n=96; in dysmenorrhoea visual analogue scale MD -23.68 points, 95% CI -28.75 to -18.62; 2 RCTs, n= 327, and a reduction in menstrual pain from baseline to the end of treatment (MD 2.10 points, 95% CI 1.38 to 2.82; 1 RCT, n=169). One underpowered unblinded trial compared COC with goserelin. At the end of treatment, the women in the goserelin group were amenorrhoeic. At 6 months' follow-up, there was no clear difference between the groups.
A systematic review 2 included 9 RCTs. The combined hormonal contraceptives significantly reduced dysmenorrhea, pelvic pain, and dyspareunia from baseline in most studies; continuous administration seemed to be more useful than cyclic administration. The effectiveness of combined hormonal contraceptives for pain reduction was similar to or less than that of oral progestins and GnRH agonists.
Comment: The quality of evidence is downgradedby study limitations (unclear allocation concealment and blinding).
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