Drospirenone-Based Low-Dose Oral Contraceptives Outperform Desogestrel in Reducing Premenstrual Symptoms: Study
About 20%-90% of women experience premenstrual syndrome (PMS), and 2%-15% of them have severe symptoms. Possible mechanisms include hormonal influences on the central nervous system; mood symptoms may reflect hormonal changes.
A preparation containing 20 μg ethinyl estradiol (EE) and 150 μg desogestrel (DSG) provided good cycle control with less treatment discontinuation because of an acceptable bleeding pattern and a decrease in PMS severity. The shortened hormone-free interval (HFI) was designed to provide greater suppression of follicle development and a more stable level of exogenous hormones throughout the menstrual cycle, thereby reducing adverse symptoms during the HFI. It was developed for patients who experience significant withdrawal symptoms.
Therefore, there was interest in whether the former low-dose combined oral contraceptive (COC) regimen could be modified into an extended 24/4 regimen to provide comparable relief from premenstrual symptoms. The purpose of this study was to compare the efficacy of low-dose COCs containing DSG with those containing drospirenone (DRSP) in reducing premenstrual symptoms.
In an open-label randomized controlled trial, 90 women with premenstrual syndrome who required COCs were randomly recruited and allocated equally to receive either six cycles of 20 μg ethinyl estradiol (EE)/150 μg desogestrel (DSG) or 20 μg EE/3 mg drospirenone (DRSP) in a 24/4 extended regimen. Analysis of covariance and repeated analysis of variance were used to determine differences in mean Women’s Health Assessment Questionnaire (WHAQ) score changes between groups, within groups, and across premenstrual, menstrual, and postmenstrual phases.
Baseline characteristics and WHAQ scores were comparable. At the end of the third and sixth cycles, mean WHAQ scores for all three phases in the DRSP group showed significant reduction and were significantly lower than those in the DSG group. The DSG group showed significant reduction in both the premenstrual and menstrual phases after the sixth cycle. Adverse effects were comparable in both groups.
This study was the first to compare the efficacy of low-dose COC formulations containing either DRSP or DSG for premenstrual symptoms. Until more data from sufficient studies demonstrate therapeutic efficacy for other modalities or other COCs, either of the COCs used in this study may be an alternative choice for selected women seeking contraception who also suffer from some degree of PMS.
Future studies may investigate the therapeutic effects of other extended COC regimens designed to minimize or eliminate the hormone-free interval, as well as other potential COCs in selected populations with premenstrual symptoms.
In conclusion, this study found that low-dose COCs containing either DSG or DRSP could reduce premenstrual symptoms. Low-dose COCs containing DRSP showed greater efficacy and earlier symptom reduction than low-dose COCs containing DSG over both three-cycle and six-cycle intervals.
Source: Hindawi Publishing Corporation, Obstetrics and Gynecology International, Volume 2013, Article ID 487143, 9 pages. DOI: 10.1155/2013/487143.
