What is the best birth control for managing dysmenorrhea (painful periods)?

Best Birth Control for Painful Periods

Combined hormonal contraceptives (CHCs) are the most effective birth control option for managing dysmenorrhea (painful periods), particularly when used in continuous or extended regimens. 1, 2

First-Line Options

• Combined hormonal contraceptives significantly reduce menstrual pain compared to placebo, with evidence showing a moderate reduction in pain intensity 1
• Continuous use of CHCs (without the hormone-free interval) is more effective for pain relief than standard cyclic regimens 1, 2
• CHCs work by suppressing ovulation and reducing endometrial lining, which decreases menstrual fluid volume and prostaglandin production that causes uterine cramping 3

Specific CHC Recommendations

• Low-dose ethinylestradiol/progestin formulations (20-30 μg ethinylestradiol) are effective while minimizing side effects 4, 1
• Extended regimens (84 days of active pills followed by 7 hormone-free days) or continuous regimens (no hormone-free days) provide better pain relief than traditional 21/7 regimens 5, 1
• Continuous regimens can induce amenorrhea in 80-100% of women by 10-12 months of use, eliminating painful periods entirely 2

Management of Side Effects

• Breakthrough bleeding is the most common side effect of CHCs, especially with continuous regimens 1, 5

• If breakthrough bleeding occurs and is bothersome:

  • For continuous CHC users, a hormone-free interval of 3-4 consecutive days may help (not recommended during first 21 days of use or more than once per month) 6
  • NSAIDs for 5-7 days can help manage breakthrough bleeding 6

• Other common side effects include:

  • Headaches (increased risk compared to placebo) 1
  • Nausea (increased risk compared to placebo) 1

Alternative Options

If CHCs are not tolerated or contraindicated:

• Levonorgestrel-releasing intrauterine device (LNG-IUD) is an excellent alternative that can reduce menstrual pain and bleeding 6
• For implant users experiencing dysmenorrhea, treatment options include:
  • NSAIDs for 5-7 days 6
  • Low-dose combined oral contraceptives for 10-20 days 6
  • Tranexamic acid for 5 days (for heavy bleeding) 6

Important Considerations

• If a woman finds her current contraceptive method unacceptable due to continued pain or side effects, healthcare providers should counsel on alternative methods and offer another option 6
• CHCs may reduce the need for additional pain medication and decrease absences from work or school 1
• Regular follow-up is important to assess satisfaction with the method and address any concerns 6

Algorithm for Selection

1. First choice: Combined hormonal contraceptives in continuous or extended regimen (if no contraindications) 1, 2
2. If breakthrough bleeding is problematic: Consider management with NSAIDs or short hormone-free interval 6
3. If CHCs are not tolerated or contraindicated: Consider LNG-IUD 6
4. If pain persists despite appropriate contraceptive use: Reevaluate for underlying conditions and consider alternative methods 6