Abstract
BackgroundUp to 80% of reproductive-aged women experience premenstrual symptoms. Premenstrual Dysphoric Disorder (PMDD) is a severe form, affecting 2-5% of women. Combined oral contraceptive pills (COCPs) are used in the treatment of PMDD. Clinical practice suggests that a newer COCP containing nomegestrol acetate (2.5mg) and 17-beta estradiol (1.5mg), may be a suitable treatment for mood symptoms in PMDD.Materials and MethodsThis was a clinical follow-up feasibility study of women who had attended the Monash Alfred Psychiatry research centre, Women’s Mental Health Clinic, with a diagnosis of PMDD. 67% of the sample also had concurrent cPTSD, 29% co-morbid anxiety, and 20% depression. They were recommended treatment with nomegestrol acetate/17-beta estradiol. Eligible women were contacted by telephone to answer a questionnaire to assess women’s subjective response to nomegestrol acetate/17-beta estradiol, acceptability and the Depression, Anxiety and Stress Scale-21 (DASS-21) after being recommended nomegestrol acetate/17-beta estradiol. The paired-sample t-test was used to determine if there were any statistically significant differences in the DASS-21 scores over the study observation period (before and after taking nomegestrol acetate/17-beta estradiol).Results35 (74.5%) women reported a subjective positive mood response to nomegestrol acetate/17-beta estradiol, 31 (63.3%) adhered to the medication, and only 10 (20.4%) women reported side effects as the main reason for discontinuing nomegestrol acetate/17-beta estradiol. There were statistically significant reductions (p<0.05) in the overall DASS-21 scores from before women commenced nomegestrol acetate/17-beta estradiol and after commencement of treatment.ConclusionsThis preliminary study supports the acceptability and effectiveness of nomegestrol acetate/17-beta estradiol as a treatment for mood symptoms in PMDD. Further research, particularly a randomized controlled trial, is required to elucidate the effect of nomegestrol acetate/17-beta estradiol treatment on mood in PMDD.
Highlights
The prevalence of premenstrual symptoms in women of reproductive age is reported to be up to 80% [1]
The mood symptoms associated with premenstrual dysphoric disorder (PMDD) cause clinically significant distress, interfering with the ability to work, quality of home life and interpersonal relationships and contributing to a high degree of morbidity in this population [3]
All women had a diagnosis of PMDD, with 33 (67.3%) women having a concurrent diagnosis of complex posttraumatic stress disorder, 28.6% of women had co-morbid anxiety and 20.4% had co-morbid depression, 18 (46.2%) women were taking an selective serotonin reuptake inhibitor (SSRI), 10 (25.6%) women were taking another antidepressant, 8 (20.0%) were taking an antipsychotic, 6 (15.4%) were taking a benzodiazepine and 13 (32.5%) were taking an anticonvulsant
Summary
The prevalence of premenstrual symptoms in women of reproductive age is reported to be up to 80% [1]. At the severe end of the spectrum is premenstrual dysphoric disorder (PMDD), affecting 2-5% of women [2]. The functional brain alterations reported in PMDD involve activation of the amygdala, insular cortex and involvement of the cerebellum, and prefrontal areas. Both hyperactivity of the amygdala and hypoactivity of the PFC are associated with PMDD symptoms severity during the late luteal phase of the menstrual cycle [5]. Premenstrual Dysphoric Disorder (PMDD) is a severe form, affecting 2-5% of women. Clinical practice suggests that a newer COCP containing nomegestrol acetate (2.5mg) and 17-beta estradiol (1.5mg), may be a suitable treatment for mood symptoms in PMDD
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