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Abnormally painful abdominal cramps during menstruation.

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Combined hormonal contraceptives taken in extended regimens for more than 28 days compare favorably to traditional 28‐day cyclic hormonal contraceptives.

Traditional combined hormonal contraceptives (CHCs), including oral contraceptive pills, the transdermal patch, and the vaginal ring, are administered daily for 21 days, followed by a hormone‐free week. During the hormone‐free week, uterine bleeding occurs. In recent years, other approaches to taking combined hormonal contraceptives have been developed. These include taking the CHCs for longer than 28 consecutive days. Some of the regimens plan occasional breaks in CHC use, while others do not. Delaying or eliminating the break in hormone use has become a popular way for women to avoid monthly bleeding, so we performed this review to compare these newer regimens to traditional CHC dosing regimens. We searched for all randomized controlled trials on this question in any language; we found twelve that met our criteria. The continuous or extended‐cycle and traditional regimens appeared similar, as judged by bleeding, discontinuation rates, and reported satisfaction. The studies were too small to address efficacy, rare adverse events, and safety. Extended‐cycle (for more than 28 days) or continuous dosing appears to be a reasonable approach to CHC use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Progestogens or progestogen‐releasing intrauterine systems for uterine fibroids

Uterine fibroids are common premenopausal benign uterine tumours. Treatment of uterine fibroids includes surgery, medical treatment, or both. Progestogens can be administered by various routes such as orally and by injection. Depot medroxyprogesterone acetate (DMPA is a synthetic progesterone hormone given by intramuscular injection that may inhibit uterine fibroid growth. The progestogen‐releasing (levonorgestrel) intrauterine system (LNG‐IUS) is a device placed inside the uterus that releases the hormone progesterone and can cause endometrial suppression. In this review, three randomised controlled studies were included. Two randomised controlled studies included 131 women and evaluated the beneficial and harmful effects of the LNG‐IUS compared with hysterectomy or a low dose combined oral contraceptive (COC). However, the results were from only one study that compared 29 women with an LNG‐IUS versus 29 women with COC for treating uterine fibroids. The LNG‐IUS appeared to reduce menstrual blood loss and increase haemoglobin levels in premenopausal women with uterine fibroids. Reduction of fibroid size was not significant. In one study that included 56 women treated with preoperative oral progestogens (lynestrenol) compared with gonadotropin‐releasing hormone (GnRH) agonist, the uterine fibroid size was not different. There was no randomised controlled study of DMPA to treat uterine fibroids. The included studies were of poor quality and had small numbers of participants. Indeed, the authors did not recommend the use of progestogens or progestogen‐releasing intrauterine systems in treating premenopausal women with uterine fibroids. More high quality randomized controlled studies evaluating progestogens or progestogen‐releasing intrauterine systems for treating uterine fibroids that have an adequate sample size are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Use of a levonorgestrel‐releasing intrauterine device (LNG‐IUD) for recurrence of symptoms in women who have had surgery for endometriosis

Endometriosis is the presence of endometrial tissue outside the uterus, usually in the pelvis, that can lead to infertility and pelvic pain. It is managed with surgery, hormonal medications, or a combination of both. The progestogen levonorgestrel is one such hormonal medication. The aim of this review was to assess whether the use of a hormone‐releasing intrauterine device was beneficial for managing associated painful symptoms and for preventing recurrence of endometriosis following surgery. Although preliminary findings are encouraging, at this stage there is only limited evidence from three randomised trials of a beneficial role with the use of the LNG‐IUD in reducing the recurrence of painful periods following surgery for endometriosis. The strength of the evidence was graded as moderate reflecting our belief that future evidence will most likely not change these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Birth control pills with three phases versus one phase

Standard birth control pills contain two hormones: progestogen and estrogen. One‐phase birth control pills contain the same dose of progestogen and estrogen every day. Four‐phase birth control pills contain different amounts of progestogen and estrogen on different days. This review looked at how well one‐phase birth control pills and four‐phase birth control pills work to prevent pregnancy, how often they cause bleeding problems, how often users experience side effects and how many women stop using the pills.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Spinal manipulation for painful periods

Painful menstrual periods (dysmenorrhoea) are caused by cramps in the uterus (womb). One of the non‐drug options for dysmenorrhoea is spinal manipulation (using the hands to put pressure on certain parts of the back bone). This procedure is sometimes offered by physiotherapists, osteopaths or chiropractors. As dysmenorrhoea may be caused by restricted blood flow, manipulating the lower spine could improve blood flow to the pelvic area. The review of trials found no evidence that spinal manipulation relieves dysmenorrhoea.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Period pain: Overview

Although menstruation is a normal part of a woman's life, severe period pain need not be. Women do not have to simply put up with it – menstrual pain can usually be treated effectively.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 12, 2013

Heavy periods: Overview

Most women do not lose much blood during their period, and only have to change their sanitary pads or tampons every few hours. Having to change these very often is a sign of heavy menstrual bleeding. If blood loss is interfering with a woman’s daily activities and making her feel weak, there are various things she can do about it.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 19, 2013

Use of progesterone or progestogen‐releasing intrauterine systems for heavy menstrual bleeding

Review question: This Cochrane review has evaluated whether the levonorgestrel–releasing intrauterine system (LNG IUS) reduces heavy menstrual bleeding and whether it is safe and acceptable.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Treatment options for heavy periods

Women with very heavy periods (menorrhagia) have various pharmaceutical and surgical treatment options. Knowing about the advantages and disadvantages of each can help make it easier to choose an appropriate therapy.The possible treatment options and the timing of treatment will depend on whether a woman wants to have a (further) child or not. The most effective treatments all affect the ability to get pregnant – either temporarily, like the pill, or permanently, like the surgical removal of the womb (hysterectomy).There are also procedures that do not involve removing the womb. Hormonal medications are not the only pharmaceutical option. There are also non-hormonal drugs that aim to reduce menstrual bleeding and help with the associated problems. If one kind of medication is not working, it is usually possible to try out other kinds of medicines or combine them.As long as the heavy periods have not caused anemia, it is possible to deal with the “heavier” days without having any treatment.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 20, 2013

Premenstrual syndrome: Overview

The days leading up to menstrual periods are sometimes a mystery to women too: Out of the blue, women with premenstrual syndrome (PMS) feel depressed, irritable, find it hard to concentrate, or cry easily. There are different ways to cope with these symptoms.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 19, 2013

Pain relievers for bleeding and pain related to intrauterine devices used for birth control

Heavy menstrual bleeding and cramping are the most common reasons why women stop using an intrauterine device (IUD) for birth control. A class of drugs (nonsteroidal anti‐inflammatory drugs, or NSAIDs) reduces menstrual bleeding and cramping in women who are not using an IUD. These drugs, such as naproxen and ibuprofen, are sold over‐the‐counter as pain relievers in many countries. Hence, researchers have studied whether these same drugs might reduce bleeding and pain associated with use of intrauterine devices. This might lead to more comfortable use of IUDs for longer periods of time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Acupuncture for pain in endometriosis

Endometriosis is a gynaecological disease that causes chronic pelvic pain, most notably painful menstruation, as the most common complaint. Acupuncture is frequently used to treat both pain and various gynaecological conditions. This review examined the effectiveness of acupuncture for reducing pain in endometriosis; however only one study met our inclusion criteria. The data from the included study, involving 67 women, indicated that ear acupuncture is more effective compared to Chinese herbal medicine for reducing menstrual pain. The study did not report whether participants suffered any side effects from their treatments. Larger, well‐designed studies comparing acupuncture with conventional therapies are necessary to confirm these results. 

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Progestagens and anti‐progestagens for pain associated with endometriosis

Endometriosis is a painful condition where tissue from the lining of the womb (uterus) is found outside the uterus as well. It can cause pain in the abdomen, generally and during periods (menstruation) or sex. Endometriosis can also lead to infertility. Treatments include surgery or drugs to try and shrink the tissue. Progestagens and anti‐progestagens are some of the hormonal drugs used for treatment. This systematic review of trials found limited evidence for the effectiveness of these drugs in the reduction of pain from endometriosis. This was due to the limited number of randomised controlled trials comparing each drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Non‐steroidal anti‐inflammatory drugs for treatment of pain in women with endometriosis

Endometriosis is a common gynaecological condition that affects women. It can lead to painful symptoms, including painful periods, pain during or after sexual intercourse, pelvic and lower abdominal pain, and infertility. It can greatly affect women's quality of life by impacting on their careers, everyday activities, sexual and non‐sexual relationships, and fertility. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are the most commonly used first‐line treatment for endometriosis because they have few side‐effects and many are available over the counter. This review found limited evidence on whether NSAIDs (naproxen) are effective for the treatment of pain caused by endometriosis. There is inconclusive evidence to show whether or not any individual NSAID is more effective than another. As shown in other Cochrane reviews, women using NSAIDs need to be aware that NSAIDs may cause adverse effects such as nausea, vomiting, headache, and drowsiness. This review is limited as it only included one study which involved 20 women.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Modern combined oral contraceptives for treatment of pain associated with endometriosis

Endometriosis is a common women's healthcare condition which is defined as the growth of endometrium (lining of the uterus) at sites outside the uterus, such as the ovaries. Endometriosis is commonly found in women with painful periods, pain with sexual intercourse, pelvic pain and infertility. Hormonal treatments, including the oral contraceptive pill (OCP) and gonadotrophin releasing hormone (GnRH) analogues are used to relieve the pain symptoms associated with endometriosis. There is some evidence to suggest that such treatments may also treat the actual deposits of endometriosis. However, many of the hormonal treatments have side effects which limit their acceptability and duration of use. Surgery may also be used to remove the deposits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Caffeine as an analgesic adjuvant for acute pain in adults

Caffeine is found in various plant products, and may be ingested in drinks like tea, coffee, and some soft drinks and energy drinks. Caffeine is a stimulant, and can improve alertness and prevent tiredness over short periods. It may disturb sleep in some people if taken before bed. Ordinary consumption of caffeine (less than 500 milligrams daily) is not harmful to health. Caffeine is commonly used in pain‐relieving medicines available from pharmacies without a prescription. An adjuvant is something that is added to a medicine to make it work better.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Managing acute lower abdominal pain in women of childbearing age

Review question: Cochrane authors reviewed available evidence on the use of laparoscopy to manage acute lower abdominal pain, non‐specific lower abdominal pain or suspected appendicitis in women of childbearing age. We found 12 studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Laparoscopic surgery for pain and subfertility associated with endometriosis

Endometriosis is the presence in inappropriate sites of tissue that normally lines the uterus. It can cause pain and subfertility. Different treatments for endometriosis are available, one of which is laparoscopic ('key hole') surgery, performed to remove visible areas of endometriosis. Cochrane review authors assessed the evidence on the use of laparoscopic surgery to treat pain and fertility problems in women with endometriosis. Laparoscopic surgical techniques include ablation, which means destruction of a lesion (for example by burning), and excision, which means cutting a lesion out.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Transcutaneous Electrical Nerve Stimulation (TENS) to treat acute pain in adults

Acute pain is pain of recent onset and limited duration. Acute pain is associated with surgery, physical trauma (e.g. broken bones, burns and cuts) and medical procedures (e.g. venepuncture and sigmoidoscopy). Transcutaneous Electrical Nerve Stimulation (TENS) is a treatment to relieve pain by administering mild electrical currents to the body using electrode pads attached to the surface of the skin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Contraception: How hormonal contraceptives like the pill work

During ovulation, a mature egg is released from the ovary, and travels down the fallopian tubes to the womb (uterus). A woman cannot get pregnant without a mature egg that can be fertilized. Most hormonal contraceptives work by suppressing ovulation.Baby girls are born with many immature eggs in their ovaries. If one of these eggs has matured and left the ovary (ovulation), the woman can get pregnant. Once a woman starts having periods (menstruation), it generally happens once a month. After ovulation, the egg travels down the fallopian tubes to the womb (uterus). If the egg is not fertilized, it dies.Hormones are produced in the body, and they act like chemical messengers. They regulate a lot of body functions. The female sex hormones estragen and gestagen regulate the monthly menstrual cycle and ovulation. They also influence body temperature.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 3, 2013

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