Oral contraceptives and premenstrual symptoms: Comparison of a 21/7 and extended regimen

• Published in: American journal of obstetrics and gynecology 2006-11, Vol.195 (5), p.1311-1319
• Main Authors: Coffee, Andrea L., Kuehl, Thomas J., Willis, Sherilyn, Sulak, Patricia J.
• Format: Article
• Language: English
• Subjects: Adult; Affect; Androstenes - administration & dosage; Androstenes - therapeutic use; Biological and medical sciences; Contraceptives, Oral, Combined - administration & dosage; Contraceptives, Oral, Combined - therapeutic use; Drospirenone; Drug Administration Schedule; Estrogens - administration & dosage; Estrogens - therapeutic use; Ethinyl Estradiol - administration & dosage; Ethinyl Estradiol - therapeutic use; Extended regimen of oral contraceptives; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Mineralocorticoid Receptor Antagonists - administration & dosage; Mineralocorticoid Receptor Antagonists - therapeutic use; Non tumoral diseases; Premenstrual symptoms; Premenstrual Syndrome - drug therapy; Premenstrual Syndrome - physiopathology; Premenstrual Syndrome - psychology; Prospective Studies; Severity of Illness Index; Treatment Outcome
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2006.05.012

The purpose of this study was to assess the incidence and severity of premenstrual-type symptoms in patients converted from a 21/7 oral contraceptive (OC) regimen to an extended regimen. This was a single center prospective analysis of the single item Scott and White (S&W) Mood Scale and the Penn State Daily Symptom Report (DSR17) during a 21/7-day followed by a 168-day extended regimen of an OC containing 3 mg of drosperinone and 30 μg of ethinyl estradiol (DRSP/EE). Of the 114 patients who began the study, 111 completed the preextension 21/7 phase of the study. There were significant differences in severity in the DSR17 and the S&W mood scale among days of the cycle. ( P < .0001) The highest values in both scales occurred during the 7-day hormone free interval (HFI) of the 21/7 cycles ( P < .001). Of the 111 patients who completed the 21/7 phase of the study, 102 (92%) completed the 168-day extended regimen. During the extended phase of the study, subjects were divided into 2 groups: those with a 100% increase in symptoms from the first half to the second half of the last 21/7 cycle were labeled as high cyclic variability, whereas those with lesser or no cyclic change were labeled as low cyclic variability. There were 55 (54%) with increased cyclic variability in mood scores peaking during the 7-day HFI. Premenstrual-type symptoms measured by both the S&W mood scale and the DSR17 instrument decreased during the extended DRSP/EE OC regimen ( P < .0001) compared with the preceding 21/7 cycle, with the greatest improvement detected in the sixth month of continuous OCs ( P < .003). The patient group with greatest cyclic variability during the 21/7 regimen demonstrated the most improvement during the 168-day regimen ( P < .0001). The single item S&W mood scale was significantly ( P < .05) correlated to each of 17 elements of the DSR17 with Spearman R correlation coefficients of 0.25 to 0.57. The greatest correlation coefficient (Spearman's R = 0.66) is with the sum of all 17 items. A 168-day extended regimen of DRSP/EE led to a decrease in premenstrual-type symptoms compared with the 21/7-day regimen.