Oral contraceptive pill for primary dysmenorrhoea.
Oral contraceptive pill for primary dysmenorrhoea.
复制标题
口服避孕药治疗原发性痛经。
DOI：
10.1002/14651858.cd002120.pub3
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
M. Proctor
中科院分区：
文献类型：
--
作者：
Chooi L Wong;C. Farquhar;H. Roberts;M. Proctor
背景
痛经(痛经)很常见。建议在原发性痛经的治疗中使用联合口服避孕药。
目标
目的：评价复方口服避孕药治疗原发性痛经的有效性和安全性。
搜索策略
我们在Cochrane月经紊乱和不孕症组对照试验注册中心、CCTR、MEDLINE、EMBASE和CINAHL(2001年首次进行，2008年11月5日更新)中进行了随机对照试验(RCT)的电子搜索。
遴选标准
将所有联合OCP与其他联合OCP、安慰剂、无处理或使用非类固醇抗炎药(NSAID)的处理进行随机对照试验。
数据收集和分析
确定了23项研究，其中包括10项研究。6人比较了联合服用OCP和安慰剂，4人比较了不同剂量的联合OCP。
主要成果
一项低剂量雌激素的研究和四项中剂量雌激素联合口服环磷酰胺与安慰剂的对比研究报告了497名女性的疼痛改善。对于不同OCP的疼痛缓解结果，与安慰剂相比，OCPs的合并或建议受益(7个随机对照试验：PETO OR 2.01[95%CI 1.32，3.08])。异质性卡方检验显示有显著的异质性，I(2)统计%和显著的卡方检验(14.06，df=5，p=0.02)。剔除不充分分配隐藏的研究的敏感性分析表明，合并OR为2.99(95%可信区间为1.76，5.07)，异质性不再具有统计学意义，I(2)统计为0%，有显著的治疗益处。有3项研究报告了不良反应(Davis 2005；Hendrix 2002；GPRG 1968)，不良反应为恶心、头痛和体重增加。两项研究报告了女性是否经历了任何副作用，但没有发现任何副作用的证据(3项随机对照试验：OR=1.45(95%0.71，2.94)。没有统计异质性的证据。没有研究证实联合口服环磷酰胺和非类固醇抗炎药相比，第三代孕前妇女的合并研究没有证据表明差异(OR=1.11(95%CI 0.79-1.57))。对于第二代和第三代，OR为0.44(95%CI为0.23-0.84)，表明第三代OCP有好处，但这是一项单一研究(Winkler 2003)。
作者的结论
有有限的证据表明，在痛经妇女中使用OCP(低剂量和中剂量雌激素)可以改善疼痛。没有证据表明不同的OCP制剂之间存在差异。
BACKGROUND
Dysmenorrhoea (painful menstrual cramps) is common. Combined OCPs are recommended in the management of primary dysmenorrhoea.
OBJECTIVES
To determine the effectiveness and safety of combined oral contraceptive pills for the management of primary dysmenorrhoea.
SEARCH STRATEGY
We conducted electronic searches for randomised controlled trials (RCTs) in the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials CENTRAL, CCTR, MEDLINE, EMBASE, and CINAHL (first conducted in 2001, updated on 5 November 2008).
SELECTION CRITERIA
RCTs comparing all combined OCPs with other combined OCPs, placebo, no management, or management with nonsteroidal anti-inflammatories (NSAIDs) were considered.
DATA COLLECTION AND ANALYSIS
Twenty three studies were identified and ten were included. Six compared the combined OCP with placebo and four compared different dosages of combined OCP.
MAIN RESULTS
One study of low dose oestrogen and four studies of medium dose oestrogen combined OCPs compared with placebo, for a combined total of 497 women, reported pain improvement. For the outcome of pain relief across the different OCPs the pooled OR suggested benefit with OCPs compared to placebo (7 RCTs: Peto OR 2.01 [95% CI 1.32, 3.08]).The Chi-squared test for heterogeneity showed there is significant heterogeneity with an I(2) statistic of 64% and a significant chi-square test (14.06, df=5, p=0.02). A sensitivity analysis removing the studies with inadequate allocation concealment suggested significant benefit of treatment with the pooled OR of 2.99 (95% CI 1.76, 5.07) and heterogeneity no longer statistically significant and I(2) statistic of 0%.Three studies reported adverse effects (Davis 2005; Hendrix 2002; GPRG 1968) The adverse effects were nausea, headaches and weight gain. Two studies reported if women experienced any side effect and no evidence of an effect was found (3 RCTs: OR = 1.45 (95% 0.71, 2.94). There was no evidence of statistical heterogeneity.There were no studies identified that compared combined OCP versus non steroidal anti-inflammatory drugsThere was no evidence of a difference for the pooled studies for 3rd generation pro gestagens (OR = 1.11 (95% CI 0.79 - 1.57)). For the 2nd generation versus 3rd generation the OR was 0.44 (95% CI 0.23-0.84) suggesting benefit of the 3rd generation OCP but this was for a single study (Winkler 2003).
AUTHORS' CONCLUSIONS
There is limited evidence for pain improvement with the use of the OCP (both low and medium dose oestrogen) in women with dysmenorrhoea. There is no evidence of a difference between different OCP preparations.