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

From the Guidelines

Hormonal contraceptives, specifically combined hormonal contraceptives (CHCs), are the most effective birth control options for managing dysmenorrhea, as they suppress ovulation and thin the uterine lining, reducing prostaglandin production and subsequent uterine contractions and pain. According to the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1, CHCs can be used to treat dysmenorrhea, and options include combined oral contraceptives, the NuvaRing vaginal ring, or the Xulane or Twirla contraceptive patches. These methods work by reducing menstrual flow and preventing ovulation, which in turn reduces the production of prostaglandins responsible for causing uterine contractions and pain during menstruation.

Some key points to consider when using hormonal contraceptives for dysmenorrhea include:

• Allowing 2-3 menstrual cycles to experience the full benefits of the chosen method
• Consulting a healthcare provider to determine the most appropriate option based on medical history and preferences
• Considering non-estrogen containing options, such as progestin-only pills, the Mirena or Liletta IUD, Depo-Provera injections, or the Nexplanon implant, for those who cannot use estrogen-containing products
• Being aware of potential side effects and interactions with other medications, and reporting any concerns to a healthcare provider

It's also important to note that the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1 emphasize the importance of exploring patient goals and preferences when managing bleeding irregularities or other side effects associated with contraceptive use. Ultimately, the best birth control option for dysmenorrhea will depend on individual patient needs and medical history, and should be determined in consultation with a healthcare provider.

From the FDA Drug Label

Controlled studies have demonstrated that ibuprofen tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea In patients with primary dysmenorrhea, ibuprofen tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions.

The best birth control for dysmenorrhea is not explicitly stated in the provided drug label, as ibuprofen is a pain reliever, not a birth control method. However, ibuprofen can be used to relieve symptoms of primary dysmenorrhea. 2

From the Research

Best Birth Control for Dysmenorrhea

• The use of combined oral contraceptive pills (OCPs) has been advocated as a treatment for primary dysmenorrhea since their introduction for general use in 1960 3.
• Combined OCPs with medium dose oestrogen (>35 mcg) and 1st/2nd generation progestogens were shown to be more effective than placebo for pain relief 3.
• There is limited evidence for pain improvement with the use of the OCP (both low and medium dose oestrogen) in women with dysmenorrhea 4, 5.
• Hormonal contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis 6.
• The treatment of primary dysmenorrhea may have different approaches, including pharmacological, non-pharmacological, and surgical, but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives 7.

Types of Birth Control

• Combined oral contraceptive pills (OCPs) are a common form of birth control used to treat dysmenorrhea 3, 4, 5.
• Low and medium dose oestrogen OCPs have been shown to be effective in reducing pain in women with dysmenorrhea 4, 5.
• 3rd generation progestagens may be more effective than 2nd generation progestagens in reducing pain in women with dysmenorrhea, but more research is needed to confirm this 4.

Side Effects and Risks

• Common side effects of OCPs include nausea, headaches, and weight gain 4, 5.
• There is no evidence of a difference in adverse effects between different OCP preparations 4, 5.
• Hormonal contraceptives may have benefits beyond pain relief, such as regulating menstrual cycles and reducing the risk of certain health conditions 6.