Practice Uncertainties Page

How effective are non-drug, non-surgical treatments for primary dysmenorrhoea?

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3011 (Published 14 May 2012) Cite this as: BMJ 2012;344:e3011
  1. Khalid S Khan, professor of women’s health and clinical epidemiology1,
  2. Rita Champaneria, systematic reviewer2,
  3. Pallavi M Latthe, subspecialist in urogynaecology, consultant obstetrician gynaecologist3
  1. 1Barts and the London School of Medicine, London E1 2DD, UK
  2. 2University of Birmingham, Birmingham B15 2TT, UK
  3. 3Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG
  1. Correspondence to: Miss R Champaneria, Birmingham Clinical Trials Unit, Robert Aitken Institute, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT r.champaneria{at}bham.ac.uk

Primary dysmenorrhoea is a common, idiopathic, chronic pelvic pain syndrome, but its unknown aetiology prevents targeted treatment. Systematic reviews and randomised controlled trials have shown that non-steroidal anti-inflammatory drugs1 2 3 4 5 and hormonal regulation through oral contraception6 are significantly more effective for pain relief than placebo and are often used for symptom control.7 8 However, some women may not always find them effective or acceptable—for example, owing to side effects in the case of non-steroidal anti-inflammatory drugs.1 Non-drug treatments, including alternative and physical therapies, are increasingly being used for dysmenorrhoea. However, their effectiveness is still being debated.

What is the evidence of the uncertainty?

This paper is based on our review in Clinical Evidence in which we examined a number of systematic reviews and trials that looked at the effects of many treatments for primary dysmenorrhoea, identified through literature searches (from database inception until January 2010) of the Cochrane Library, Medline, Embase, and bibliographic databases of the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency.9

The quality of available evidence was moderate to poor, for both drug and non-drug treatments. In particular, well designed trials comparing interventions head to head or against placebo were scarce. The meta-analyses found that drug treatments (non-steroidal anti-inflammatory drugs and combined oral contraception) were effective. Evidence on surgical treatments found that laparoscopic uterine nerve ablation was ineffective.29 30 31 For non-drug treatments the review showed substantive uncertainty, which hampers the generation of clinical guidance. The table shows the results of our examination.

View this table:

Non-drug, non-surgical treatments for primary dysmenorrhoea

Transcutaneous electrical nerve stimulation (TENS)

A Cochrane review included seven very low quality randomised controlled trials (RCTs) of this physical treatment.10 Patients had greater pain relief with high frequency TENS than placebo (odds ratio 7.2, 95% confidence interval 3.1 to 16.5), but low …

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