Evaluation of a unique oral contraceptive (Yasmin) in the management of premenstrual dysphoric disorder

Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
The European Journal of Contraception and Reproductive Health Care (Impact Factor: 1.39). 01/2003; 7 Suppl 3(suppl 3):27-34; discussion 42-3.
Source: PubMed


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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    • "Among anti-anxiety agents, alprazolam obtained inconsistent effects,26-29 while buspirone showed weak efficacy.30,31 Suppression of ovulation with oral contraceptives like the drospirenone/ethinylestradiol combination,32-34 GnRH agonists,35 the synthetic steroid 17alpha-ethinyl testosterone,36 or ovariectomy,37,38 significantly reduces or eliminates symptoms. Other treatments include diuretics, such as spironolactone,39 and non-steroidal anti-inflammatory drugs (NSAIDs),40,41 that are shown to reduce symptoms such as bloating, pain and headache. "
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    ABSTRACT: The treatment of premenstrual dysphoric disorder (PMDD) is far from satisfactory, as there is a high proportion of patients who do not respond to conventional treatment. The antidiuretic sulfonamide, acetazolamide, inhibits carbonic anhydrase and potentiates GABAergic transmission; the latter is putatively involved in PMDD. We therefore tried acetazolamide in a series of women with intractable PMDD. Here, we describe a series of eight women diagnosed with DSM-IV-TR PMDD, five of whom had comorbidity with a mood disorder and one with an anxiety disorder, who were resistant to treatment and responded with symptom disappearance after being added-on 125 mg/day acetazolamide for 7-10 days prior to menses each month. Patients were free from premenstrual symptoms at the 12-month follow-up. We suggest that acetazolamide may be used to improve symptoms of PMDD in cases not responding to other treatments. GABAergic mechanisms may be involved in counteracting PMDD symptoms.
    Psychiatry investigation 01/2014; 11(1):95-101. DOI:10.4306/pi.2014.11.1.95 · 1.28 Impact Factor
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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. "
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    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.
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