From the Guidelines
Progestin-only options, particularly the levonorgestrel intrauterine system, are the most effective treatments for dysmenorrhea, providing relief for up to 5-7 years by thinning the endometrium and reducing menstrual flow and prostaglandin production. The choice of progestin-only option depends on various factors, including the patient's medical history, preferences, and potential contraindications.
Progestin-Only Options
- Levonorgestrel intrauterine system (Mirena, Liletta): provides relief for up to 5-7 years, with a failure rate of less than 1% 1
- Etonogestrel implants (Nexplanon): offer 3 years of protection, with a failure rate of less than 1% 1
- Progestin-only pills (norethindrone 0.35mg, drospirenone 4mg): taken daily, with a failure rate of 5-8% 1
- Depot medroxyprogesterone acetate (DMPA) injections: given every 12 weeks, with a failure rate of 3% 1, but may increase the risk of venous thromboembolism (VTE) 1
Considerations
- Patients with antiphospholipid antibody (aPL) positivity should avoid combined estrogen-progestin contraceptives due to the increased risk of thromboembolism 1
- Progestin-only pills or IUDs are recommended for patients with aPL positivity, as they do not increase the risk of VTE 1
- Copper IUDs are also a highly effective alternative, but may increase menstrual bleeding and cramping for several months after insertion 1
Side Effects
- Irregular bleeding initially, which typically improves over time
- Potential benefits for patients with endometriosis-related dysmenorrhea, including higher doses of progestins like norethindrone acetate (5-10mg daily) or dienogest (2mg daily) 1
From the Research
Progestin Only Options for Dysmenorrhea
- Progestin-only options are not explicitly mentioned as a treatment for dysmenorrhea in the provided studies 2, 3, 4, 5.
- However, hormonal contraceptives, which often contain progestin, are mentioned as a first-line medical option for treating dysmenorrhea 2, 3, 5.
- Selective progesterone receptor modulators (SPRMs) are being researched as a potential treatment for dysmenorrhea, particularly for secondary dysmenorrhea related to uterine diseases such as endometriosis, adenomyosis, and uterine fibroids 6.
- Examples of SPRMs include mifepristone, telapristone acetate, vilaprisan, ulipristal acetate, and asoprisnil, which have antagonistic or mixed effects on progesterone receptors 6.
- It is essential to note that the provided studies do not specifically discuss progestin-only options for dysmenorrhea, and more research is needed to determine their effectiveness as a treatment.
Limitations and Future Research
- The current evidence is limited to hormonal contraceptives and SPRMs, and there is a need for further research on progestin-only options for dysmenorrhea.
- Studies should investigate the efficacy and safety of progestin-only treatments for primary and secondary dysmenorrhea, as well as their potential benefits and drawbacks compared to other treatment options 2, 3, 4, 5, 6.