Does progestin-only contraceptive use after pregnancy affect recovery from pelvic girdle pain? A prospective population study.

Elisabeth Krefting Bjelland,Siri Vangen,Katrine Mari Owe,Hedvig Marie Egeland Nordeng,Malin Eberhard-Gran,Per Kristiansson,Bo Lars Engdahl

doi:10.1371/journal.pone.0184071

Abstract

ObjectiveTo estimate associations of progestin-only contraceptives with persistent pelvic girdle pain 18 months after delivery.MethodsProspective population based cohort study during the years 2003–2011. We included 20,493 women enrolled in the Norwegian Mother and Child Cohort Study who reported pelvic girdle pain in pregnancy week 30. Data were obtained by 3 self-administered questionnaires and the exposure was obtained by linkage to the Prescription Database of Norway. The outcome was pelvic girdle pain 18 months after delivery.ResultsPelvic girdle pain 18 months after delivery was reported by 9.7% (957/9830) of women with dispense of a progestin-only contraceptive and by 10.5% (1114/10,663) of women without dispense (adjusted odds ratio 0.93; 95% CI 0.84–1.02). In sub-analyses, long duration of exposure to a progestin intrauterine device or progestin-only oral contraceptives was associated with reduced odds of persistent pelvic girdle pain (Ptrend = 0.021 and Ptrend = 0.005). Conversely, long duration of exposure to progestin injections and/or a progestin implant was associated with modest increased odds of persistent pelvic girdle pain (Ptrend = 0.046). Early timing of progestin-only contraceptive dispense following delivery (≤3 months) was not significantly associated with persistent pelvic girdle pain.ConclusionsOur findings suggest a small beneficial effect of progestin intrauterine devices and progestin-only oral contraceptives on recovery from pelvic girdle pain. We cannot completely rule out an opposing adverse effect of exposure to progestin injections and/or progestin implants. However, the modest increased odds of persistent pelvic girdle pain among these users could be a result of unmeasured confounding.

Highlights

Pelvic girdle pain is commonly reported during pregnancy [1] and diminishes shortly after delivery in most women [2]
Pelvic girdle pain 18 months after delivery was reported by 9.7% (957/9830) of women with dispense of a progestin-only contraceptive and by 10.5% (1114/10,663) of women without dispense
In sub-analyses, long duration of exposure to a progestin intrauterine device or progestin-only oral contraceptives was associated with reduced odds of persistent pelvic girdle pain (Ptrend = 0.021 and Ptrend = 0.005)

Summary

Introduction

Pelvic girdle pain is commonly reported during pregnancy [1] and diminishes shortly after delivery in most women [2]. Modifiable factors that may influence recovery of pelvic girdle pain have been insufficiently studied. Two large observational studies have reported an inverse association between age at menarche and pelvic girdle pain [6, 7], suggesting an influence of endogenous hormonal factors. We observed that the use of a progestin intrauterine device during the last year before pregnancy and long-term exposure to progestin-only contraceptive pills were associated with the development of pelvic girdle pain during pregnancy [10]. Exacerbation of symptoms following the insertion of a progestin intrauterine device has been observed in the clinic [11, 12] effects of hormonal contraceptives on recovery from pelvic girdle pain have barely been studied. Large prospective studies with long follow-up time and detailed information about hormonal contraceptives are needed to determine potential impact on recovery

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Conclusion