Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women

Kristen A Johnson; Lindsey A Sjaarda; Sunni L Mumford; Rebecca A Garbose; Karen C Schliep; Donald Mattison; Neil J Perkins; Jean Wactawski-Wende; Enrique F Schisterman

doi:10.1002/pds.3993

Menstrual Cycle · Cycle Physiology

Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women

Johnson KA, Sjaarda LA, Mumford SL, Garbose RA, Schliep KC, Mattison D, Perkins NJ, Wactawski-Wende J, Schisterman EF

Published June 2016 Pharmacoepidemiology and drug safety, 25(6), 618-627

DOI 10.1002/pds.3993 PMID 26954695 PMC PMC4933290

RRM Academy Synopsis

Healthy women use pain medication most during menses

In a cohort of 259 healthy women followed for two cycles, pain and central nervous system medication use was highest during menses. Antibiotic use was highest in the luteal phase. In all, 188 women reported using some medication.

Key Findings

Of 259 healthy women not using hormonal contraception, 188 (73%) reported any medication use during the study, which followed most women across two complete menstrual cycles.
Pain medication was the most frequently used category, taken by 179 women. Musculoskeletal medication was the least used, taken by 3 women.
Pain medication use varied across the cycle (p < 0.001) and was higher in the early phase, which included menses, than in the mid or late phase (both p < 0.0001).
Central nervous system medication use was higher in the early than the late phase (p = 0.004). Antibiotic use was higher in the late than the early phase (p = 0.039).
Allergy, cold and cough, and gastrointestinal medication use did not vary across the cycle, although use of several categories, including these, varied by season.

Interpretation

The study is a prospective cohort. It describes when women used medication across the cycle. The women were young, healthy, and mostly white. The authors excluded hormonal contraception, menstrual or ovulatory disorders, laparoscopy-confirmed endometriosis, and attempts to conceive. Only 18 women used antibiotics and 8 used central nervous system medication. The authors write that a future study is needed to learn if the luteal antibiotic pattern is chance. Women filled out daily diaries by self-report, which may misclassify use. The daily assessment did not include the reason for use, particularly for antibiotics.

RRM Context

The authors suggest that pain medication use likely reflects menstrual pain. Restorative reproductive medicine looks for the cause of cycle-linked pain. A charted cycle shows where in the cycle the pain falls. The researchers timed visits with fertility monitors and lined up each woman's days with estimated ovulation. That cycle-timed design allows the phase-by-phase comparison.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

The purpose of this study is to characterize the patterns of medication intake in healthy, reproductive-age women not using hormonal contraception.

Methods

Two hundered fifty-nine healthy, premenopausal women (18-44 years of age) enrolled in the BioCycle Study (2005-2007) were followed over two menstrual cycles. Women were excluded if they were currently using oral contraceptives or other chronic medications. Over-the-counter and prescription medication use among participants was evaluated daily throughout the study via a diary assessing type of medication, dosage, units, and frequency. Medications were categorized as allergy, antibiotics, central nervous system (CNS), cold and cough, gastrointestinal, musculoskeletal, and pain medication based on primary active ingredient. Medication use within each category was assessed across standardized 28-day cycles to evaluate differences in use across cycle phases (i.e., early, middle, and late).

Results

Medication use was reported by 73% of participants. The most and least frequently used medications, respectively, were pain (69%) and musculoskeletal medications (1%). Pain, CNS, and antibiotic medication use varied significantly across the cycle, with pain and CNS medication more frequently reported during menses and antibiotics more frequently during the luteal phase. Allergy, cold and cough, gastrointestinal, and musculoskeletal medication use did not vary across the cycle.

Conclusions

Patterns of medication use among reproductive age women vary across the menstrual cycle for certain types of medications, particularly in pain (e.g., Ibuprofen), antibiotics (e,g, Amoxicillin), and CNS (e.g., Adderall) medications. Future studies involving use of these types of medication in premenopausal women may need to consider the relationship of their use to the menstrual cycle.

Topics

Menstrual Cycle › Cycle Physiology › Cycle Variability · Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency

Kristen A Johnson, Lindsey A Sjaarda, Sunni L Mumford, Rebecca A Garbose, Karen C Schliep, Donald Mattison, Neil J Perkins, Jean Wactawski-Wende, Enrique F Schisterman

K Johnson, L Sjaarda, S Mumford, Becky Garbose, R Garbose, K Schliep, Don Mattison, D Mattison, N Perkins, J Wactawski-Wende, E Schisterman

PMID 26954695 26954695 DOI 10.1002/pds.3993 10.1002/pds.3993 Johnson et al. 2016, Johnson 2016

Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women

Healthy women use pain medication most during menses

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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