BACKGROUND AND PURPOSE:

• Combined oral contraceptives are often used as treatment for women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) but data on efficacy is limited
• In a review and meta-analysis, de Wit et al. (AJOG, 2021) assessed the efficacy of combined oral contraceptives in managing premenstrual depressive symptoms

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • RCTs
  • Studies that evaluated the efficacy of combined oral contraceptives in women with PMS or PMDD
• Study design
  • Random effect Bayesian pairwise and network meta-analysis
  • Certainty of evidence was assessed using GRADE criteria
• Primary outcome
  • Change in premenstrual depressive symptoms and overall premenstrual symptomatology between baseline and 3 cycles

RESULTS:

• 9 trials | 1205 women
  • Mean age: 24.6 to 36.5 years
• Combined oral contraceptives were more efficacious than placebo in treating overall premenstrual symptomatology
  • Standardized mean difference 0.41 (95% CI, 0.17 to 0.67)
• Combined oral contraceptives did not have a significant effect on premenstrual depressive symptoms specifically
  • Standardized mean difference 0.22 (95% CI, -0.06 to 0.47)
• None of the combined oral contraceptives were more effective than others in reducing premenstrual depressive symptoms and overall premenstrual symptomatology

CONCLUSION:

• The use of combined oral contraceptives may improve overall premenstrual symptoms for those with PMS or PMDD, but not premenstrual depressive symptoms
• No one type of combined oral contraceptive was superior to another for symptom reduction
• The authors state

In women who predominantly complain about depressive symptoms, other commonly used treatment options for women with PMDD, such as selective serotonin reuptake inhibitors and cognitive-behavioral therapy, might be a more effective approach

In contrast to what is often thought, there was no evidence for a difference in efficacy among formulations containing drospirenone and other formulations or a 24-day regimen vs other regimens

Learn More – Primary Sources:

Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials

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