New Treatment Approaches for Premenstrual Disorders

Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1740, USA.
The American journal of managed care (Impact Factor: 2.26). 01/2006; 11(16 Suppl):S480-91.
Source: PubMed


Several approaches to alleviating the symptoms of premenstrual disorders are available to women and can be tailored according to individual needs and preferences. This article discusses methods that entail changes to lifestyle and diet and managing life stresses without relying on drug therapy, as well as a variety of medications that may be necessary in addition to or in place of recommended lifestyle modifications. New pharmacologic research is promising and is discussed along with the need to provide empathetic counseling for patients to determine the approach that will work best for each individual.

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    • "Overall, studies of OCs have shown mixed effectiveness and in some cases worsening of symptoms. In general, OCs appear to have more impact on the physical symptoms rather than mood-related symptoms.1,6,23,41 However, a newer OC containing the progestin drospirenone, which is a derivative of spironolactone, has been shown to relieve both physical and mood symptoms. "
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    ABSTRACT: Premenstrual dysphoric disorder (PMDD) is estimated to affect 3%-8% of reproductive age women. Multiple therapeutic modalities have been evaluated with varying efficacy for the associated somatic and mood symptoms. The majority of older studies had shown that oral contraceptive pills (OCs) were most effective for the physical symptoms. However, newer OCs containing a novel progestin, drospirenone, have shown promise in alleviating both the somatic and affective/behavioral symptoms. This progestin, which is a derivative of spironolactone, has both antimineralocorticoid and antiandrogenic activity. A 24/4 formulation containing 20 μg of ethinyl estradiol has been found effective in randomized double-blind placebo-controlled trials utilizing established scales documenting symptoms associated with PMDD. Multiple studies have shown that drospirenone-containing OCs are safe without evidence of clinically adverse effects on carbohydrate metabolism, lipids, blood pressure, weight, serum potassium or increased thrombotic events compared to other low dose OCs. In addition, significant improvements have been demonstrated in acne, hirsutism, and fluid retention symptoms. Several open label studies demonstrated good patient compliance and reported satisfaction with the method. Because of the significant placebo effect demonstrated in the blinded placebo-controlled trials, additional large randomized placebo-controlled trials are needed to confirm the efficacy of the drospirenone OCs in the treatment of PMDD. However, this OC formulation appears to be a promising therapeutic modality.
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    ABSTRACT: Das prämenstruelle Syndrom ist mit 20–30% eines der häufigsten zyklusabhängigen Beschwerdebilder der Frau zwischen dem 20. und 40. Lebensjahr. Es tritt fast ausschließlich in der Lutealphase ovulatorischer Zyklen auf. Die Ätiologie ist praktisch unbekannt, das serotoninerge Transmitter-System spielt eine wesentliche Rolle bei Befindlichkeitsstörungen. Die Diagnostik konzentriert sich in erster Linie auf eine exakte Zyklusanamnese, um das PMS z. B. von Formen der Depression zu differenzieren. Zur medikamentösen Therapie sind Serotoninwiederaufnahmehemmer erfolgreich, eingesetzt werden aber auch Aldosteronantagonisten z. B. bei Ödemneigung. Die ovulationshemmende Wirkung von hormonalen Kontrazeptiva unterdrückt ebenfalls das PMS. Invasive Therapiemaßnahmen wie GnRH-Analoga sind Ausnahmesituationen vorbehalten.
    Gynäkologische Endokrinologie 01/2004; 2(2). DOI:10.1007/s10304-004-0060-y

  • Women s Health 03/2006; 2(2):183-5. DOI:10.2217/17455057.2.2.183
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