Do Combination oral contraceptives relieve premenstrual depressive symptoms?

According to a recent study headed by Anouk E. de Wit, combined oral contraceptives may improve overall premenstrual symptomatology in women with premenstrual syndrome or premenstrual dysphoric disorder, but not premenstrual depressive symptoms. Further there is no proof that one combination of oral contraceptive is more effective than another.

The findings of this study were published in the American Journal of Obstetrics & Gynecology.

Combined oral contraceptives are frequently considered a therapy option for women suffering from premenstrual syndrome or premenstrual dysphoric disorder who are also looking for contraception, however evidence for this treatment is limited.

The goal of this study was to assess (1) the amount of evidence for the efficacy of combined oral contraceptives in treating premenstrual depression symptoms and total premenstrual symptomatology, and (2) the comparative efficacy of combination oral contraceptives (CRD42020205510).

For this study, from conception until June 3, 2021, researchers examined the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, PsycINFO, EMCare, and Embase. This meta-analysis included all randomized clinical studies that assessed the effectiveness of combination oral contraceptives in women with premenstrual syndrome or premenstrual dysphoric disorder.

A random effect Bayesian pairwise and network meta-analysis was performed, with the result being a change in premenstrual depressed symptoms and total premenstrual symptomatology between baseline and three cycles. The evidence's certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation process.

The key findings of this work were as follow:

1. There were 9 suitable studies out of 3664 records that evaluated 1205 women with premenstrual syndrome or premenstrual dysphoric disorder (mean age per study range, 24.6e36.5 years).

2. According to the pairwise meta-analysis, combined oral contraceptives were more effective than placebo in treating overall premenstrual symptomatology (standardized mean difference, 0.41; 95% credible interval, 0.17e0.67), but not specifically premenstrual depressive symptoms (standardized mean difference, 0.22; 95% credible interval, 0.06 to 0.47).

3. However, none of the combination oral contraceptives outperformed the others in terms of lowering premenstrual depressed symptoms and total premenstrual symptomatology.

According to the findings of this pairwise and network meta-analysis, combined oral contraceptives may improve overall premenstrual symptomatology in women with PMS or PMDD, although there is presently no evidence to recommend one combination of oral contraceptives over another. Furthermore, there was no evidence that combination oral contraceptives are beneficial in alleviating premenstrual depression symptoms, which are frequently the predominant complaint of women with PMDD. Few trials for each formulation of combination oral contraceptives were available, and the certainty of evidence for each comparison was graded as extremely poor.

The Authors concluded that, more randomized clinical trials with head-to-head comparisons of combination oral contraceptives are thus required to identify which formulation is most beneficial for premenstrual symptoms in women with PMS and PMDD.

Reference:

Anouk E. de Wit, Ymkje Anna de Vries, Marrit K. de Boer, Celeste Scheper, Ante Fokkema, Catharina A.H. Janssen, Erik J. Giltay, Robert A. Schoevers, Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials, American Journal of Obstetrics and Gynecology, https://doi.org/10.1016/j.ajog.2021.06.090.