From the Guidelines
For a teenager with dysmenorrhea, a combined oral contraceptive pill (COC) containing 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate is recommended. This recommendation is based on the guidance provided by the American Academy of Pediatrics, as outlined in the study published in Pediatrics in 2014 1. The study suggests that any "low-dose" pill, containing 35 μg or less of ethinyl estradiol, can be used for adolescents.
Key Considerations
- The choice of COC should be based on the individual's needs and medical history, with consideration of potential side effects and interactions with other medications.
- Patients should be counseled on the importance of daily adherence to the pill regimen, with strategies such as cell phone alarms and support from a family member or partner.
- If a pill is missed, it should be taken as soon as possible, and the remaining pills should be taken at the usual time, with consideration of emergency contraception if necessary, as outlined in the study 1.
- Extended or continuous cycles may be useful for treating medical conditions such as severe dysmenorrhea, endometriosis, and heavy menstrual bleeding, as well as for adolescents who prefer amenorrhea.
Potential Side Effects and Interactions
- Common transient adverse effects of COCs include irregular bleeding, headache, and nausea, as noted in the study 1.
- Drug interactions should be avoided, particularly with medications that decrease COC effectiveness, such as anticonvulsants and antiretroviral drugs.
- Patients should be informed of the potential increased risk of blood clots associated with COC use, although this risk is still relatively low, as reported in the study 1.
Monitoring and Follow-up
- A routine follow-up visit 1 to 3 months after initiating COCs is recommended to address any adverse effects or adherence issues, as suggested in the study 1.
- Patients should be monitored for any changes in their medical history or condition that may affect the safety and efficacy of COC use.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Combined Oral Contraceptive Pills for Dysmenorrhea in Teenagers
- The use of combined oral contraceptive pills (COCs) for the treatment of dysmenorrhea in teenagers has been studied in several trials 2, 3, 4, 5.
- A randomized, double-blind, placebo-controlled clinical trial found that a low-dose oral contraceptive (ethinyl estradiol 20 microg and levonorgestrel 100 microg) was more effective than placebo in relieving dysmenorrhea-associated pain in adolescents 2.
- Another study compared the efficacy of continuous norethisterone acetate versus cyclical drospirenone 3 mg/ethinyl estradiol 20 μg for the management of primary dysmenorrhea in young adult women, and found that both treatments were effective in suppressing dysmenorrhea 4.
- A prospective observational cohort study found that both monophasic 24/4 estradiol/nomegestrol acetate and 21/7 ethinyl-estradiol/chlormadinone acetate oral contraceptives significantly reduced primary dysmenorrhea, with similar efficacy 5.
- When choosing a COC for a teenager with dysmenorrhea, factors such as the type of progestin, potency, and antiandrogenic properties should be considered, as well as the individual patient's needs and medical history 6.
Types of Combined Oral Contraceptive Pills
- Low-dose oral contraceptives, such as ethinyl estradiol 20 microg and levonorgestrel 100 microg, have been shown to be effective in relieving dysmenorrhea-associated pain in adolescents 2.
- Extended-cycle oral contraceptives, such as those containing levonorgestrel 100 μg and ethinyl estradiol 20 μg, may also be an option for teenagers with dysmenorrhea 3.
- Monophasic 24/4 estradiol/nomegestrol acetate and 21/7 ethinyl-estradiol/chlormadinone acetate oral contraceptives have been found to be effective in reducing primary dysmenorrhea 5.