Hur effektiva är orala preventivmedel innehållande drospirenon i kombination med etinylöstradiol vid behandling av premenstruella symtom?

Sammanfattning: Background: Premenstrual syndrome (PMS) are common in more than 75 % of all women with menstruation. The prevalence of moderate to severe PMS is 20-40 % and the prevalence of premenstrual dysphoric disorder (PMDD) is 3-8 %. PMS occur in the form of physical and psychological symptoms a few weeks before menstruation and then disappears during the first days of menstruation. Common symptoms are anxiety, lack of energy, depressed mood, irritability, breast tension, headache, social withdrawal, bloating, sleep disturbances, affective lability and decreased concentration. PMDD is a more severe form of PMS where both affective and somatic symptoms are required as well as five out of eleven symptoms, of which one symptom must be of a more severe nature linked to the mood. In order to diagnose PMDD, the symptoms in accordance with the criteria in DSM-IV or DSM-V should have been present in most menstrual cycles during the past year. The etiology is unclear but sex hormones appear to play an important role in exacerbating the symptoms. There is a relationship between hormonal changes and premenstrual symptoms. Hormone levels change during the menstrual cycle. In PMS and PMDD the symptoms occur during the late luteal phase and disappear again the first days of menstruation. In the treatment of PMS and PMDD, treatment is used as SSRIs, combined oral contraceptives, diuretics such as spironolactone and GnRH-agonists. According to guidelines from RCOG the first-line treatment of moderate to severe PMS and PMDD is oral contraceptives containing drospirenone/ethinyl estradiol (EE) or SSRIs. Non-pharmacological treatment is recommended for mild symptoms. Combined oral contraceptives prevent ovulation and hormonal fluctuations during the menstrual cycle. Aim: The aim of the literature study was to investigate the effect of an oral contraceptive containing the combination of drospirenone and ethinyl estradiol in the treatment of PMS and PMDD. Method: A literature study was conducted in which six scientific articles retrieved from PubMed were reviewed. Two of the studies were double-blind, randomized and placebo-controlled. Two studies were randomized comparative studies who compared drospirenone/EE with other progestins such as levonorgestrel and desogestrel combined with EE. The other two studies were uncontrolled clinical trials. All six studies investigated the effect of drospirenone/EE on premenstrual symptoms. Results: The result showed a decrease in premenstrual symptoms in all six studies included in this literature study. Drospirenone as a progestogen had a greater symptom improvement than levonorgestrel or desogestrel. Drospirenone/EE in the 24/4 regimen effectively reduced symptoms of PMDD. Drospirenone/EE in the 21/7 regimen significantly reduced water retention and negative effects. There was a placebo-response in two of the studies. Conclusion: Oral combined contraceptives containing drospirenone/EE may have good decreasing effect on premenstrual symptoms in women suffering from PMS or PMDD. Both affective and somatic symptoms can be significantly improved.