The Grapevine

Non-Steroidal Anti-Inflammatory Drugs May Interfere With Ovulation After Only Ten Days Of Use

Pills
Those pain pills may come with a side of infertility. Photo Courtesy of Shutterstock

For women attempting to become mothers, that bottle of aleve may be more trouble than it’s worth, according to a new study to be presented this week at the European League Against Rheumatism Annual Congress (EULAR 2015). It found that three groups of women who each took a different non-steroidal anti-inflammatory drug (NSAID) were significantly less likely to ovulate than a control group. The study adds to a growing base of evidence showing that NSAIDs can stunt fertility.

The study authors had 39 fertile women with accompanying back pain take either 100 milligrams of diclofenac, 1000 milligrams of naproxen (known to most by its brand name of Aleve), 90 milligrams of etoricoxib or an inactive sugar pill daily. They took these drugs for ten days, beginning on the tenth day of their period, when a woman’s ovary is in the middle of preparing the egg to be released from the follicle so that it can attach to the lining of the uterus. Only about six percent of diclofenac users and about 25 percent of naproxen and etoricoxib users each ovulated by the end of the trial, compared to 100 percent of the placebo group.

This was likely largely due to the fact that the women on NSAIDs were significantly less likely to have their egg break free from the follicle in the first place. The egg of 75 percent, 25 percent and 33 percent of women who took diclofenac, naproxen and etoricoxib respectively remained unstirred from its slumber. "After just ten days of treatment we saw a significant decrease in progesterone, a hormone essential for ovulation, across all treatment groups, as well as functional cysts in one third of patients," said study author Professor Sami Salman of the University of Baghdad, Iraq in a press statement. "These findings show that even short-term use of these popular, over-the-counter drugs could have a significant impact on a woman's ability to have children."

Of the three medications, only naproxen is readily available over-the-counter (OTC) in the United States (most OTC preparations contain 220 milligram per pill). Diclofenac is offered through prescription while the FDA has not certified etoricoxib for use -- the organization has stated that it needs additional evidence of its safety before approval. Worldwide, however, all three drugs are often used to deal with low-to-middle grade pain. And earlier studies have implicated other NSAIDs in causing infertility as well. A 2006 study in the Journal of Clinical Pharmacology found that meloxicam had a similar stunting effect on healthy volunteers.

For those who might be worried, the effect seems to be temporary and these drugs still carry relatively little risk otherwise. "Only minor side effects were reported by volunteers during the course of treatment," the 2006 study found. We may even be able to utilize it to our benefit. "Meloxicam 30 milligrams given for five consecutive days in the late follicular phase is safe, effective, and may be an alternative form of emergency contraception," a 2009 study in Human Reproduction concluded.

But one woman’s contraception can be another woman’s unexpected barrenness so the authors advise that clinicians begin letting women who are regularly using NSAIDS know upfront about what they’re getting into. “This needs to be better communicated to patients with rheumatic diseases, who may take these drugs on a regular basis with little awareness of the impact,” said Salman.

Source: Salman S, et al. Effects of some non steroidal anti-inflammatory drugs on ovulation in women with mild musculoskeletal pain. EULAR 2015. 2015.

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