The effect of pycnogenol on patients with dysmenorrhea using low-dose oral contraceptives

OBJECTIVE: Menstrual symptoms such as dysmenorrhea usually occur during the hormone-free interval in oral contraceptive users. Progestin withdrawal activates NF-kappaB transcription factor which upregulates both vascular endothelial growth factor (VEGF) and Cox-2 expression in the endometrium. The use of natural NF-kappaB inhibitors such as pycnogenol may block this response improving dysmenorrhea. PATIENTS AND METHODS: Twenty-four patients with severe dysmenorrhea were allocated to one of two treatment groups. In Group A (n=13) women were treated with an oral contraceptive containing 15 mug of ethinyl estradiol and 60 mg of gestodene (Adoless((R))) in a 24/4 regimen for three consecutive cycles. Women in Group B (n=11) used the same contraceptive regimen together with 100 mg of pycnogenol (Flebon((R))) continuously for 3 months. Pain scores were graded using a visual analog scale (VAS) before and during the hormone-free interval at the end of the third treatment cycle. RESULTS: Before treatment VAS pain scores for dysmenorrhea were 8 and 9 in Groups A and B respectively. However by the end of the third treatment cycle pain scores had decreased significantly (P<0.05) both in groups A and B. The final pain scores were 6 in Group A and 2 in Group B a difference that was statistically significant (P<0.0001). In Group B 27% of the patients became pain-free while in Group A none of the women reported complete disappearance of this symptom. The number of bleeding days was also lower in Group B. DISCUSSION: Pycnogenol effectively decreased pain scores and the number of bleeding days when administered concomitantly with a low-dose 24/4 oral contraceptive containing gestodene.