Contraception has always been associated with family planning, whereby a couple chooses a method that prevents pregnancy until when they deem, they want to bear a child. This has been successful, more so in developing countries where cases of teenage pregnancies have been alleviated. However, recent research has shed some light on the possible merits of contraception on period associated pain in women of reproductive age. The paper discusses possible treatments through the use of various contraception methods based on the needs of the patient in the given case study.
Painful menstruation, commonly referred to as dysmenorrhea, is a common phenomenon among women of reproductive age. Dysmenorrhea occurs when prostaglandins, chemical agents that are formed on the lining of the uterus during menstruation, cause muscle contractions in the uterus and, in turn, lead to pain and decreased blood flow to the uterus. The condition affects about 50% to 90% of all reproductive-age women worldwide (Gebeyehu et al., 2017).
Delegate your assignment to our experts and they will do the rest.
Damm et al. (2019) note that dysmenorrhea occurs in two forms, i.e., primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea lacks discernible macroscopic pathology, while the latter results from underlying conditions such as endometriosis or uterine fibroids. In the case at hand, the 25-year-old Latina patient did not present with any abnormalities during her gynecological exam, thus lying more onto the primary dysmenorrhea category.
Smith & Kaunitz (2019) suggest that there exist several treatment options for dysmenorrhea. Among the methods noted by the authors is birth control pills, which contain hormones as the active ingredient. The authors note that these hormonal agents work by thinning the endometrium, thus reducing the number of prostaglandins formed. This consequently leads to decreased uterine contractions and menstrual bleeding that contribute to reduced pain and cramping. Additionally, Ryan (2017) compound Smith & Kaunitz’s work by noting that hormonal treatments are vital in the management of primary dysmenorrhea. Ryan further goes ahead to suggest the use of both NSAIDs and hormonal therapy for best results in dysmenorrhea patients.
While it is evident that oral contraceptives have the potential to mitigate dysmenorrhea, the problem comes in choosing the right drug for the right patient. Jaisamrarn & Santibenchakul (2018) conducted a study on the efficacy of combined oral contraceptives, each with a different active ingredient in the treatment of dysmenorrhea and acne. The drugs at hand varied in that one contained chlormadinone acetate, while the other contained drospirenone as the respective progestogen component. The authors' findings indicated that the chlormadinone acetate progestogen drug was more effective when compared to the drospirenone when it came to the treatment of dysmenorrhea. Additionally, the authors noted that chlormadinone acetate reported that 66% of the subjects reported being cured of dysmenorrhea, while 14% of them had reduced symptoms after 12 cycles of the drug. These numbers were significantly better than those reported on drospirenone, as only 65% of the subjects reported reduced dysmenorrhoeic severity with no cure rates after nine treatment cycles.
In summary, the CMA dosage is at 2.0mg per tablet, while drospirenone is at 3.0mg per tablet. The former requires about 12 cycles for best results, while the latter shows the best results after nine cycles of treatment. For patients who do not agree with the above recommendations, Smith & Kaunitz (2019) and Ryan (2017) suggest the use of nonsteroidal anti-inflammatory drugs combined with oral contraceptives for increased efficacy. It is, however, vital to begin the NSAIDs as soon as bleeding or other menstrual symptoms begin, and then take them on a regular schedule for about three days. However, patients opting for the use of NSAIDs should be aware of the significant risk of adverse side effects such as mild headaches and nausea. About 53% of patients on NSAIDs for period pain experience relief when the drug is appropriately administered. Alternatively, the authors suggest the use of an intrauterine device that contains hormone levonorgestrel to reduce dysmenorrhea. This therapy can reduce the symptoms by as much as 50% depending on the tolerance levels of the individual and adherence. Generally, hormonal therapy, in the form of contraceptives, remains the best-case treatment of menstrual cramping among women of reproductive age.
References
Damm, T., Lamvu, G., Carrillo, J., Ouyang, C., & Feranec, J. (2019). Continuous vs. cyclic combined hormonal contraceptives for treatment of dysmenorrhea: a systematic review. Contraception: X , 1 , 100002.
Gebeyehu, M. B., Mekuria, A. B., Tefera, Y. G., Andarge, D. A., Debay, Y. B., Bejiga, G. S., & Gebresillassie, B. M. (2017). Prevalence, impact, and management practice of dysmenorrhea among University of Gondar Students, Northwestern Ethiopia: a cross- sectional study. International journal of reproductive medicine , 2017 .
Jaisamrarn, U., & Santibenchakul, S. (2018). A comparison of combined oral contraceptives containing chlormadinone acetate versus drospirenone for the treatment of acne and dysmenorrhea: a randomized trial. Contraception and reproductive medicine , 3 (1), 5.
Ryan, S. A. (2017). The treatment of dysmenorrhea. Pediatric Clinics , 64 (2), 331-342.
Smith, R. P., & Kaunitz, A. M. (2019). Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/painful-menstrual-periods-dysmenorrhea-beyond- the-basics
