Oral contraceptive helps with severe PMS

A new low-dose oral contraceptive pill reduces symptoms of Premenstrual syndrome (PMS), including a severe form called Premenstrual dysphoric disorder, US researchers report.

"Oral contraceptives are commonly used for premenstrual conditions, usually milder syndromes, but the empirical evidence supporting their use has been lacking," said Dr. Kimberley A. Yonkers of Yale University School of Medicine, New Haven, Connecticut. "This is the first study to show that an oral contraceptive is better than placebo for any premenstrual syndrome, including Premenstrual dysphoric disorder."

The agent contains "a low dose of ethinyl estradiol - 20 micrograms - and a newer progestin, drospirenone, that is an analogue of the diuretic agent, spironolactone," she explained.

Premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression, irritability, and tension before menstruation. These symptoms are more severe than those seen with premenstrual syndrome (PMS).

The causes of PMS and PMDD have not been identified, although social, cultural, biological, and psychological factors all appear to be involved. Researchers estimate that PMDD affects between 3% and 8% of women in their reproductive years.

To investigate its effects, Yonkers and colleagues randomly assigned 450 women with symptoms of premenstrual dysphoric disorder to receive the oral contraceptive or placebo. The active formulation was administered for 24 days followed by 4 days of inactive pills.

"Response, defined as a 50 percent decrease in daily symptoms scores, occurred in 48 percent of the active-treatment group and 36 percent of the placebo group," the team reports in the medical journal Obstetrics and Gynecology.

Premenstrual syndrome (PMS) involves symptoms that occur in relation to the menstrual cycle and which interfere with the woman's life. The symptoms usually begin 5 to 11 days before the start of menstruation. Symptoms usually stop when menstruation begins, or shortly thereafter.
Yonkers added that the dosing schedule, 24 days of active treatment and 4 days of "blanks," rather than the usual 21 days of active treatment and 7 days of blanks, "may have contributed to its" therapeutic benefits.

SOURCE: Obstetrics and Gynecology, September 2005.