1515 INCIDENCE OF PELVIC PAIN SYMPTOMS IN COMMUNITY- DWELLING YOUNG WOMEN AND RELATIONSHIP TO USE AND TYPE OF ORAL CONTRACEPTIVE PILLS
INTRODUCTION AND OBJECTIVES
The oral contraceptive pill (OCP) has evolved with hormonal dosage reductions. The lowest estrogen OCPs decrease free testosterone and suppress estrogen production, with replacement of low concentrations of ethinyl estradiol which can lead to hypoestrogenic effects on vaginal tissue. The purpose of our study was to compare chronic pelvic pain symptoms (CPSS) between young women who are current OCP users and non−users.
An anonymous, internet−based survey was conducted in women aged 18−39 within two large university populations via list−serve emails. Women were excluded if they were pregnant, had a history of endometriosis or pelvic pain. We collected demographic data, type of OCP, duration of use and indication for usage. OCPs were classified by estrogen content into low−dose and normal dose (¡Ü20 or >20mcg). Subjects were classified as not taking OCP or taking a low or a high dose. Participants were asked to complete the NIH−CPSI questionnaire and were classified as having CPPS if their total index pain score was ¡Ý4. Outcomes were compared between groups using SPSS and chi−square test.
1117 women responded to the survey and 932 were eligible, 605 women were non−OCP users and 327 were OCP users (169 low−dose and 171 normal dose). We found significant differences in the incidence of individual pelvic pain symptoms between OCP users and non−users and further differences with low−dose use. Overall low−dose OCP users were more likely to report pelvic pain symptoms and more likely to have CPPS than non−users (27.1% vs 17.5%, p=0.045). Conversely, normal dose OCP users were less likely to have pelvic pain symptoms overall than non OCP users. For ¡° pain or discomfort during or after sexual climax¡±low−dose OCP users had almost twice the incidence compared to controls (25.2% vs 12.3%, p=0.002), there was no difference between normal dose OCP users and controls. There was a trend towards low−dose OCP users having more perineal pain (15% vs 8.9%, p=0.054) and more pain during urination (14.3% vs 9.0%, p=0.096) than controls. 44% of respondents reported onset of pain after beginning OCP use and were more likely to fulfill CPPS criteria than those who had symptoms prior to OCP use (62% versus 30.3%, p<0.001).
Low−dose OCPs appear to increase the incidence of CPPS and pain during sexual climax, while normal dose OCPs have similar incidence of CPPS to non−users and appear to be protective in individual pelvic pain symptoms.