Clinic for Endocrinology and Reproductive Medicine, University Hospital Freiburg, Freiburg, Germany.
Contraception. 2010 Mar;81(3):185-96. doi: 10.1016/j.contraception.2009.09.014. Epub 2009 Nov 6.
This article is a comprehensive overview of dysmenorrhea and a systematic review of the available literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives for the therapy and management of dysmenorrhea.
A comprehensive search of the PubMed database for clinical trials and observational studies of dysmenorrhea treatments from 2004 onwards.
Eighteen publications were identified. Ten randomized controlled trials (RCTs) assessing NSAIDs for treating primary dysmenorrhea demonstrated superior pain relief compared with placebo, but no superiority was established among different NSAIDS. Two RCTs and six nonrandomized observational or prospective studies assessing the effect of hormonal contraceptives on dysmenorrhea strongly suggest a beneficial effect for dysmenorrheic pain relief and were conducted mainly in larger populations (N=41-6169) than those in the NSAID trials (N=10-337). Ethinylestradiol/chlormadinone acetate was the only formulation that provided a more pronounced relief of dysmenorrheic pain compared with a parallel alternative or previously used hormonal contraceptive. Methodological inconsistencies were widespread between the hormonal contraceptive studies.
The findings of this review support the use of NSAIDs as a first-line therapy for pain relief from dysmenorrhea in women without wish for contraception. For women who wish contraception, combined oral contraceptives (COCs) are the preferential therapy for pain relief from dysmenorrhea as the additional noncontraceptive benefit of pain relief from dysmenorrhea is not linked to additional risks, eliminates the risks associated with taking NSAIDs and is a more suitable long-term option. Recommendations are made to strengthen the impact of future trials through improved methodology.
本文是一篇关于痛经的综合概述，对现有关于非甾体抗炎药（NSAIDs）和激素避孕药治疗和管理痛经的文献进行了系统评价。
对 2004 年以来关于痛经治疗的临床试验和观察性研究的 PubMed 数据库进行全面检索。
确定了 18 篇文献。10 项评估 NSAIDs 治疗原发性痛经的随机对照试验（RCT）显示与安慰剂相比疼痛缓解更优，但不同 NSAIDs 之间未确立优势。2 项 RCT 和 6 项非随机观察性或前瞻性研究评估了激素避孕药对痛经的影响，强烈提示激素避孕药对痛经缓解有益，且这些研究主要纳入了比 NSAIDs 试验（N=10-337）更大的人群（N=41-6169）。屈螺酮炔雌醇/双醋炔诺醇是唯一一种与平行替代药物或之前使用的激素避孕药相比能更显著缓解痛经的制剂。激素避孕药研究之间方法学的不一致性普遍存在。
本综述的研究结果支持 NSAIDs 作为痛经止痛的一线治疗药物，适用于无避孕需求的女性。对于有避孕需求的女性，复方口服避孕药（COC）是缓解痛经的首选疗法，因为缓解痛经带来的非避孕益处与额外风险无关，消除了服用 NSAIDs 相关的风险，并且是更适合的长期选择。建议通过改进方法学来增强未来试验的影响力。
