Premenstrual syndrome

Abstract

In their Seminar on premenstrual syndrome, Kimberly Yonkers and colleagues (April 5, p 1200)1Yonkers KA O'Brien PMS Eriksson E Premenstrual syndrome.Lancet. 2008; 371: 1200-1210Summary Full Text Full Text PDF PubMed Scopus (320) Google Scholar suggest that a hormone-free interval of 4 days rather than 7 days of a combined oral contraceptive, as well as a new contraceptive containing drospirenone, could have a beneficial effect in relieving symptoms in women with premenstrual syndrome.We published a systematic review2Lopez LM Kaptein A Helmerhorst FM Oral contraceptives containing drospirenone for premenstrual syndrome.Cochrane Database Syst Rev. 2008; 1 (CD006586.)Google Scholar on drospirenone-containing oral contraceptives for premenstrual syndrome based on five randomised controlled trials (a total of 1600 women). Four trials were sponsored by the manufacturer of the pills. Differences in diagnosis and clinically relevant endpoints, as well as poor methods, hampered a robust overall conclusion. We were not able to ascertain whether drospirenone-containing oral contraceptives work after three cycles, for women with non-severe symptoms, or better than other combined oral contraceptives. Placebos had a large effect. In two of the five trials (Yonkers contributed to both trials), drospirenone plus only 20 μg ethinyloestradiol was compared with a placebo, and a hormone-free interval of 4 days rather than 7 days was used. Lumping the results, a positive effect on symptoms of premenstrual dysphoric disorder—a severe form of premenstrual syndrome—was seen.Before we prescribe the pill to women with premenstrual dysphoric disorder, we should wait for convincing results of an independently conducted randomised controlled trial according CONSORT, with a fair comparison: firstly a placebo, and, if beneficial, with the gold standard in combined oral contraceptives (levonogestrel plus 30 μg ethinyloestradiol).We declare that we have no conflict of interest. In their Seminar on premenstrual syndrome, Kimberly Yonkers and colleagues (April 5, p 1200)1Yonkers KA O'Brien PMS Eriksson E Premenstrual syndrome.Lancet. 2008; 371: 1200-1210Summary Full Text Full Text PDF PubMed Scopus (320) Google Scholar suggest that a hormone-free interval of 4 days rather than 7 days of a combined oral contraceptive, as well as a new contraceptive containing drospirenone, could have a beneficial effect in relieving symptoms in women with premenstrual syndrome. We published a systematic review2Lopez LM Kaptein A Helmerhorst FM Oral contraceptives containing drospirenone for premenstrual syndrome.Cochrane Database Syst Rev. 2008; 1 (CD006586.)Google Scholar on drospirenone-containing oral contraceptives for premenstrual syndrome based on five randomised controlled trials (a total of 1600 women). Four trials were sponsored by the manufacturer of the pills. Differences in diagnosis and clinically relevant endpoints, as well as poor methods, hampered a robust overall conclusion. We were not able to ascertain whether drospirenone-containing oral contraceptives work after three cycles, for women with non-severe symptoms, or better than other combined oral contraceptives. Placebos had a large effect. In two of the five trials (Yonkers contributed to both trials), drospirenone plus only 20 μg ethinyloestradiol was compared with a placebo, and a hormone-free interval of 4 days rather than 7 days was used. Lumping the results, a positive effect on symptoms of premenstrual dysphoric disorder—a severe form of premenstrual syndrome—was seen. Before we prescribe the pill to women with premenstrual dysphoric disorder, we should wait for convincing results of an independently conducted randomised controlled trial according CONSORT, with a fair comparison: firstly a placebo, and, if beneficial, with the gold standard in combined oral contraceptives (levonogestrel plus 30 μg ethinyloestradiol). We declare that we have no conflict of interest. Premenstrual syndrome – Authors' replyOur Seminar points out the paucity of randomised clinical trials that test the efficacy of oral contraceptives in the treatment of premenstrual syndrome. Given that oral contraceptives are among the most commonly prescribed agents to treat premenstrual syndrome and reliably result in ovulation suppression, the lack of work is startling. Full-Text PDF