Impact of the prostaglandin synthase-2 inhibitor celecoxib on ovulation and luteal events in women.
Level 2 - randomized trial
Randomized, double-blind crossover trial
PubMed 22902348 · doi:10.1016/j.contraception.2012.07.004
What was done
In a randomized, double-blind crossover trial, 20 ovulatory, reproductive-aged women underwent ovarian ultrasound and serum hormone monitoring across four menstrual cycles (control cycle, treatment cycle 1, washout cycle, treatment cycle 2). Participants received oral celecoxib 400 mg or placebo either once daily from cycle day 8 until follicle rupture/menses (pre-LH surge dosing) or once daily starting at the LH surge for 6 days (post-LH surge dosing). Outcomes were ovulatory and luteal dysfunction determined by inhibited/delayed follicle rupture and reduced luteal progesterone synthesis or lifespan.
What was found
All 20 enrolled subjects completed the study. Compared to control cycles, celecoxib treatment significantly increased ovulatory dysfunction: 30% (6/20) with pre-LH treatment (p = .04) and 25% (5/20) with post-LH treatment (p = .04). Mean peak progesterone, estradiol, LH levels, and luteal phase length did not differ significantly between control and either treatment cycle.
Why it matters
Although selective COX-2 inhibition interferes with follicular rupture in a minority of cycles, the vast majority of women still ovulate normally, indicating celecoxib has limited utility as an emergency contraceptive.
Limits
The sample size was small (n = 20), limiting precision. The study evaluated surrogate markers of fertility (ultrasound evidence of rupture and hormone levels) rather than pregnancy prevention, and tested only a single dosage regimen of celecoxib.
Cited by
- supports Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen around the time of ovulation can inhibit the acute inflammatory cascade and prevent the ovarian follicle from rupturing.
- supports Taking NSAID medications outside of menstruation during the menstrual cycle can prevent ovulation from occurring.