The Pill for PMS relief? New research says yes
Your next patient says she has breast tenderness, headaches, bloating, and weight gain during the luteal phase of her menstrual cycle, which indicates premenstrual syndrome (PMS). What is your next move?
New research indicates that use of the oral contraceptive (OC) Yasmin decreased the physical and emotional symptoms associated with a woman’s menstrual cycle.1 "We have ongoing clinical trials right now for a different dose of Yasmin in premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS," reports Kim Schillace, company spokeswoman for the drug’s manufacturer, Berlex Laboratories of Montville, NJ. "We will seek that indication if the data come back in a positive way."
The company is examining use of a lower dose of the currently available oral contraceptive (3 mg drospirenone and 0.030 mg ethinyl estradiol), states Schillace.
Look at the results
In the latest published research, scientists tracked and scored the physical, behavioral, and emotional symptoms of PMS reported by women at three phases of their menstrual cycle and before and after use of Yasmin. Study participants reported being better able to perform daily activities after beginning therapy and said their general sense of well-being improved during their menstrual cycle.
After starting use of the drug, the number of women reporting that PMS affected their daily activities moderately, quite a bit, or extremely was reduced from 30% to 16% of participants. Similarly, the number of study participants reporting that PMS affected their general well-being moderately to extremely dropped from 35% to 21% following use of the drug therapy.
In new oral contraceptive users, researchers noted improvements in symptoms during the four days before the period and during menstruation, including those associated with water retention (weight gain, skin disorders, painful breasts, and swelling), as well as those in the negative affect cluster (crying, loneliness, anxiety, restlessness, irritability, mood swings, depression, tension, and food cravings). For these patients, the improvement in negative affect also extended into the remainder of the cycle, except crying and loneliness. For patients who had switched to Yasmin from other oral contraceptives, improvements were noted for all phases of the cycle.
Yasmin’s progestin may be the key to the drug’s impact on PMS symptoms, theorizes Andrea Rapkin, MD, study author and professor of obstetrics and gynecology at the University of California, Los Angeles. The progestins used in other combined oral contraceptives are derived from testosterone, she explains. While chemically different, they still may retain androgenic properties, which may result in weight gain and appetite increase.
"This particular pill is derived from a chemical which is related to spironolactone, which is a diuretic and an anti-androgenic compound," states Rapkin. "It is progestogenic, which you need for birth control, but at the same time, it has other properties that would suggest that you would have fewer side effects and better quality of life with this pill."
What is PMDD?
Make the distinction between PMS and PMDD when evaluating patients’ symptoms. To diagnose PMDD, symptoms must occur during the week preceding menses and remit several days after the onset of menstruation. Symptoms may include five of the following: markedly depressed mood, anxiety or tension, affective lability, anger or increased irritability resulting in increased interpersonal conflicts, decreased interest in usual activities, difficulty concentrating, lethargy or easy fatigability, changes in appetite, sleep disturbances (hypersomnia or insomnia), and a feeling of being overwhelmed, plus physical symptoms such as breast tenderness, headaches, joint/muscle pain, bloating, or weight gain.2
Selective serotonin reuptake inhibitors (SSRIs), such as Sarafem (fluoxetine, Eli Lilly & Co., Indianapolis) have been effective in treating PMDD, notes Rapkin. However, side effects such as nausea, dry mouth, decreased libido, and insomnia have been problematic for some patients. Research into other drugs would afford more treatment options, she notes.
"We know that there seems to be some relationship with the syndrome and serotonin, so other medications which alter seratonergic profile without the side effects of SSRIs, for example, might be very helpful," Rapkin comments. "In addition, the concept of using a contraceptive pill continuously rather than cyclically, where you don’t have the small cycles of hormone fluctuation that you have with the cyclic pill, also might be useful."
1. Borenstein J, Yu H-T, Wade S, et al. Effect of an oral contraceptive containing ethinyl estradiol and drospirenone on premenstrual symptomatology and health-related quality of life. J Repro Med 2003; 48:79-85.
2. Karpa K. For women only. Drug Topics 2001; 2:51.