Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Perspective from Kurt R. Wharton, MD, FACOG
Disclosures: The authors report no relevant financial disclosures.
August 30, 2021
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‘Optimal’ treatment for premenstrual depressive symptoms remains elusive

Perspective from Kurt R. Wharton, MD, FACOG
Disclosures: The authors report no relevant financial disclosures.
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Although combined oral contraceptives improved overall premenstrual symptomatology in women with PMS or premenstrual dysphoric disorder, the birth control pills did not improve premenstrual depressive symptoms, data show.

In addition, there was “no evidence for one combined oral contraceptive being more efficacious than any other” for these conditions, researchers said.

De Wit AE, et al. Am J Obstet Gynecol. 2021;doi:10:1016/j.ajog.2021.06.090
De Wit AE, et al. Am J Obstet Gynecol. 2021;doi:10:1016/j.ajog.2021.06.090.

Data indicate as many as 12.2% of menstruating women are affected by PMS and as many as 5.3% of these women experience PMDD.

“Combined oral contraceptives containing drospirenone are the only formulations that are approved by the FDA for treating PMDD,” Anouk E. de Wit, MD, of the department of psychiatry at the University Medical Center Groningen in the Netherlands, told Healio.

In addition, the results of previous trials involving various dosing levels of ethinylestradiol/drospirenone (including 20 µg/3 mg and 30 µg/3 mg) and ethinylestradiol/levonorgestrel (such as 20 µg/90 ug), when analyzed separately, have left doubt regarding their efficacy for treating premenstrual symptomatology in PMS and PMDD, according to the researchers.

Therefore, de Wit and colleagues conducted a meta-analysis of nine randomized trials that evaluated the effect of combined oral contraceptives in women with PMS or PMDD. The analysis included a total 1,205 women (mean age per study range = 24.6-36.5 years).

Their results, published in the American Journal of Obstetrics & Gynecology, indicated that the combined oral contraceptives were more efficacious when compared with placebo in treating overall premenstrual symptomatology (standardized mean difference = 0.41; 95% CrI, 0.17-0.67) but not premenstrual depressive symptoms specifically (standardized mean difference = 0.22; 95% CrI, –0.06 to 0.47). None of the combined oral contraceptives was more effective than the other in reducing premenstrual depressive symptoms and overall premenstrual symptomatology.

“Physicians should take this into account when prescribing combined oral contraceptives, as depressive symptoms are often the main symptoms in women with PMDD,” the researchers wrote.

Anouk E. de Wit

The results also indicate that “patients with PMDD can opt for their preferred combined oral contraceptive,” de Wit said in the interview.

In addition to the oral contraceptives in the study, serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy have also been used to treat premenstrual-related depressive symptoms, according to the researchers. They cautioned that the “certainty of evidence for all available treatments is very low to moderate at best, which highlights that optimal treatment strategies are not yet well-established.”