Low dose progestin releasing contraceptives are associated with a higher pain threshold in healthy women

Women who used progestin-containing contraceptives had higher pain thresholds than healthy controls.


Manuela Menezes Máximo, M.D., Patrícia Silveira Silva, M.D., Carolina Sales Vieira, Ph.D., Thaís Mangetti Gonçalvez, Júlio Cesar Rosa-e-Silva, Ph.D., Francisco José Candido-dos-Reis, Ph.D., Antonio Alberto Nogueira, Ph.D., Omero Benedicto Poli-Neto, Ph.D.

Volume 104, Issue 5, Pages 1182-1189



To determine the pain thresholds of women taking different formulations of hormonal contraceptives.


Cross-sectional study.


Basic health care unit.


Eighty-nine healthy nonusers and 188 users of hormonal contraceptives.


Subject interviews were followed by the application of a semistructured questionnaire, including a psychometric assessment with the Beck Depression Inventory and the State-Trait Anxiety Inventory. After the interview, a 10-mL peripheral blood sample was collected. Pain thresholds were obtained by performing pressure algometry.

Main Outcome Measure(s):

Serum concentrations of E2, P, and T (free fraction) were determined via chemoluminescence. The menstrual cycle phase was determined according to hormonal level and identification of an LH surge in urine. Pain threshold was evaluated with a dynamometer applied to the forearm skin of the nondominant limb and abdominal wall.


Progestin-only contraceptive users showed a higher pain pressure threshold in the forearm (2.94 ± 0.96 vs. 2.74 ± 0.89 vs. 2.62 ± 0.92) and right (2.11 ± 0.87 vs. 1.83 ± 0.81 vs. 1.78 ± 0.77) and left abdomen (2.12 ± 0.88 vs. 1.79 ± 0.76 vs. 1.73 ± 0.70) than did combined hormonal contraceptive users and nonusers of hormonal contraceptives, respectively. Users of contraceptives that continuously release etonogestrel (subcutaneous implant, vaginal ring) or levonorgestrel (intrauterine devices) had higher pain thresholds.


Women who used hormonal contraceptives enabling continuous release of etonogestrel or levonorgestrel tended to have higher pain thresholds than did nonusers of hormonal contraceptives.

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