Nonsteroidal anti-inflammatory drugs in primary dysmenorrhea
Level of evidence: B
Nonsteroidal anti-inflammatory drugs likely have a large impact on primary dysmenorrhea related pain.
A Cochrane systematic review and meta-analysis «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 compared nonsteroidal anti-inflammatory drugs with placebo, with paracetamol and with each other in the treatment of primary dysmenorrhea. Naproxen (21 studies) and ibuprofen (6 studies) were the most used NSAID interventions. NSAIDs led to a large reduction in dysmenorrhea related pain (mean difference 6.24, 95 % confidence interval 4.69 to 7.78, scale 0-10), and increased the probability of moderate or excellent pain relief (odds ratio 4.37, 95 % confidence interval 3.76 to 5.09).
NSAIDs were more likely to cause an adverse effect than placebo (OR 1.29, 95% CI 1.11 to 1.51, I2 = 0%). Most reported adverse effects were mild neurological and gastrointestinal symptoms.
The evidence certainty was downgraded due to high risk of bias.
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 | SR/MA of RCTs | Women with primary dysmenorrhoea in outpatient settings. | NSAIDs vs placebo | Pain relief and adverse effects | High |
| Reference | Comments |
|---|---|
| «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 | Risk of bias: poor reporting of study methods and protocols especially concerning randomisation, some selective outcome reporting. Some risk of publication bias due to high proportion of commercially funded studies. |
Results
| Level of evidence: moderate The quality of evidence is downgraded due to study limitations and potential publication bias. I= intervention; C=comparison; CI=confidence interval | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 | 35 studies, 1768 patients | one to five menstrual cycles | OR 4.37 (3.76, 5.09) | ||
| Level of evidence: moderate The quality of evidence is downgraded due to study limitations and potential publication bias. I=intervention; C=comparison; CI=confidence interval | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Mean Difference (95% CI) |
|---|---|---|---|---|---|
| «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 | 4 studies, 503 patients | three to four menstrual cycles | MD 6.24 (4.69, 7.78) | ||
| Level of evidence: moderate The quality of evidence is downgraded due to study limitations and potential publication bias. I=intervention; C=comparison; CI=confidence interval | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| «Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 »1 | 25 studies, 2133 patients | one to five menstrual cycles | OR 1.29 (1.11, 1.51) | ||
References
- Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015;2015(7):CD001751 «PMID: 26224322»PubMed