Evaluation of a unique oral contraceptive (Yasmin) in the management of premenstrual dysphoric disorder
ABSTRACT Over three-quarters of women experience some physical and emotional changes associated with the menstrual cycle. Irritability, tension, fatigue, depression, breast tenderness and bloating are among the most common premenstrual symptoms. Approximately 5-10% of women of childbearing age experience premenstrual symptoms to a degree that disrupts their functioning in the home or workplace and that meet criteria for premenstrual dysphoric disorder (PMDD). Serotonergic antidepressants are clearly effective for PMDD, with about 60% of subjects responding to this treatment in controlled studies. Oral contraceptives are commonly used to treat premenstrual symptoms but are an understudied intervention with no information on their efficacy for PMDD). The recent introduction of an oral contraceptive (Yasmin, Schering AG, Berlin, Germany), containing low-dose ethinylestradiol (EE) combined with a new progestogen, drospirenone (DRSP), may offer clinical efficacy for PMDD as a result of the unique pharmacological profile of this progestogen, which is a spirolactone derivative with antimineralocorticoid and antiandrogenic activity. A randomized, placebo-controlled study of DRSP/EE in women with PMDD found a consistently greater reduction of symptoms-from baseline for all 22 premenstrual symptoms assessed (using the Calendar of Premenstrual Experiences, COPE) and for the four statistically derived symptom factors in the group taking DRSP/EE compared to the placebo group. For appetite, acne and food craving (factor 3), the difference between the DRSP/EE group and the placebo group was statistically significant (p = 0.027). These preliminary results suggest the beneficial effect of DRSP/EE on PMDD and offer an alternative class of medication that also provides the range of benefits of oral contraception for women with PMDD.
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- "Also, as subjects who had been prospectively defined as suffering from premenstrual syndrome (PMS) were more prone to report negative mood while on COCs (Cullberg, 1972), the prevalence of PMS or premenstrual dysphoric disorder (PMDD) prior to COC use could contribute to these adverse mood effects. Drospirenone is a spironolactone analog with antimineralocorticoid and antiandrogenic activities and drospirenone-containing COCs have been evaluated in several recent studies for treatment of PMDD with positive results (Freeman, 2002; Pearlstein et al., 2005). However, the possibility still remains that certain women with severe PMS, or subthreshold PMDD, are more likely to suffer from adverse mood effects during COC use than women with no cyclical mood changes. "
ABSTRACT: Negative mood symptoms remain one of the major reasons for discontinuation of oral contraceptive pills. The aim of this study was to compare acoustic startle response and prepulse inhibition (PPI) in women with different experience of oral contraceptive pills. Thirty women currently on combined oral contraceptives (COCs) with no reports of adverse mood symptoms, 28 women currently on COCs and experiencing mood-related side effects from treatment, 27 women who had discontinued COC use for reasons other than adverse mood symptoms and 32 women who had discontinued COC use due to adverse mood effects were included. The eyeblink component of the acoustic startle reflex was assessed using electromyographic measurements of musculus Orbicularis Oculi. Twenty pulse-alone trials (115dB 40ms broad-band white noise) and 40 prepulse-pulse trials were presented. The prepulse stimuli consisted of a 115dB 40ms noise burst preceded at a 100ms interval by 20ms prepulses that were 72, 74, 78, or 86dB. Patients with adverse mood effects of COCs exhibited lower levels of PPI with 86dB prepulse compared to COC users with no adverse effects of COCs (p<0.05). There was no difference in PPI between the two groups of prior COC users. No significant difference was found between the groups regarding acoustic startle response. Relative to COC users with no reports of adverse mood symptoms, subjects suffering from COC-induced negative mood displayed deficits in PPI of acoustic startle. The fact that there was no difference in PPI between the two groups of prior COC users indicates that deficient PPI is related to adverse mood effects caused by COCs.Psychoneuroendocrinology 06/2008; 33(4):487-96. DOI:10.1016/j.psyneuen.2008.01.007 · 5.59 Impact Factor
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ABSTRACT: The purpose of this study was to describe the experience of persons with allergic respiratory symptoms who practice yoga as a self-healing modality. Fifteen participants were interviewed. Using the content analysis method, 5 themes emerged from the data: perceived positive effects, powerful and harmonious inner energy, mindfulness and self-awareness, understanding self and others, and promoting and achieving a state of balance and harmony. These findings foster the value of knowing the experience of persons who practice yoga as an intervention in holistic nursing.Holistic nursing practice 03/2011; 25(2):63-70. DOI:10.1097/HNP.0b013e31820dbbae · 0.52 Impact Factor
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ABSTRACT: This review discusses the current status of diagnosis and treatment of premenstrual dysphoric disorder (PMDD), with an emphasis on studies that have been published in the medical literature during the 2001 to 2002 interval. Serotonergic antidepressants are effective for PMDD, and are currently considered the first-line treatment. Recent clinical trials have shown that selective serotonin reuptake inhibitors, taken only during the symptomatic luteal phase, are also effective for PMDD. One study reported efficacy for a slow-release formulation of fluoxetine that was taken two times during the menstrual cycle. Oral contraceptives still lack definitive evidence of efficacy as a treatment for PMDD, although a new contraceptive formulation has appeared promising for the mood and behavioral symptoms of the disorder. The results of a meta-analysis of the published trials of progesterone and progestins further indicate that these hormones are not effective in the management of PMDD.Current Psychiatry Reports 01/2003; 4(6):435-40. DOI:10.1007/s11920-002-0071-0 · 3.05 Impact Factor