1. Over-the-counter analgesic use was most common during menstruation.
2. Women using over-the-counter pain relievers were less likely to experience an anovulatory cycle.
Evidence Rating Level: 2 (Good)
Study Rundown: Over-the-counter (OTC) pain relievers, including acetaminophen, ibuprofen, aspirin and naproxen, are medications commonly used to manage conditions ranging from fever to osteoarthritis to menstrual cramps. While each analgesic has known adverse effects, when used appropriately, these OTC medications are considered to have a good safety profile. However, little is known about their impact on female reproductive function even though they are more commonly used by women. Prior work has suggested that OTC analgesic use may be associated with delays in ovulation, but the few existing studies have been small or retrospective in nature. In the present work, authors collected prospective data to evaluate the relationship between the use of OTC pain relievers, reproductive hormone levels and ovulatory function. Findings demonstrate that OTC analgesic use is associated with higher levels of progesterone and a lower likelihood of anovulation. While these results suggest that OTC analgesic use is not detrimental to reproductive function, they do not imply that OTC pain relievers should be used therapeutically to improve ovulatory function.
Strengths of the study included prospective design and sub-analyses of several OTC medications. Limitations included self-report and a short follow-up period. Further randomized trials assessing longer-term clinical outcomes such as pregnancy rates are needed to better characterize the effects of pain relievers on reproductive function.
In-Depth [prospective cohort]: This study explored the impact of OTC pain relievers on reproductive hormones and ovulatory function in female users (n = 179) and non-users (n = 80). Outcomes of interest were anovulatory cycles, as well as estradiol, luteinizing hormone, and follicle-stimulating hormone levels.
OTC analgesic use was highest during menstruation. OTC analgesic users had increased blood loss during menstruation (p = 0.025), heavier menstrual flow (p = 0.0048) and higher levels of progesterone during the luteal phase (p = 0.017). Women who used OTC pain medications during the follicular phase were less likely to experience an anovulatory cycle (OR 0.32, CI 0.16-0.65).
Image: CC/Wikimedia Commons/Derrick Coetzee
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