Women's health

Premenstrual dysphoric disorder

Mood swings, depression, irritability, loss of control, as well as physical symptoms such as breast tenderness and a feeling of bloatedness – these are symptoms that many women regularly experience during their menstrual cycle. The medical term for this condition is premenstrual syndrome (PMS).

Monthly crisis

An estimated three to eight percent of all women of childbearing age are particularly affected by severe premenstrual complaints; termed premenstrual dysphoric disorder, or PMDD. This describes a condition in which at least five classic PMS symptoms occur together – and in a particularly severe form: e.g. a very depressed state of mind with feelings of great despair or severe irritability.

The resulting subjective suffering can be very severe and can last for up to two weeks per monthly cycle. The symptoms of PMDD usually have an adverse effect on the patient's family and social life and restrict her ability to work.

Because the symptoms are seemingly non-specific, and also because many sufferers regard the symptoms as a normal part of their cycle, most women who suffer from PMDD go undiagnosed. In the U.S. alone, it is estimated that up to 90 percent of the probably 4.5 million women suffering from PMS are affected.

Hormone sensitivity could be a factor

It is unclear why some women suffer from PMDD while others do not. For a long time the cause was suspected in differences in hormone concentrations, but in the meantime we know that women with PMDD symptoms hardly differ in this respect from women with no symptoms.

Another assumption is that it is not so much the hormone concentrations that are decisive, but primarily the sensitivity of certain receptors in the central nervous system to these hormones. In particular, a crucial role could be played by sensitivity to the hormone progesterone and its increased levels after ovulation.

Contraceptives can help

From research findings, two different approaches have been developed up to now. One approach is to directly influence receptors in the central nervous system. For example, certain antidepressants are a way of treating the emotional symptoms of PMDD.

Other treatment approaches aim to prevent ovulation. An option in extreme cases is the surgical removal of the ovaries. But it is also possible to inhibit ovulation by using oral contraceptives. The problem is that oral contraceptives contain a synthetic progesterone component (progestin), that, like natural progesterone, can again aggravate or even cause the PMDD symptoms – despite inhibiting ovulation.

Bayer offers an oral contraceptive that stands out in this context. It contains the progestin drospirenone, which in its pharmacological profile differs markedly from other synthetic progestins. It seems that it is due to this difference that drospirenone may contribute to an ease of the usual symptoms. Two clinical studies have confirmed this effect. In one study, the severity of the complaints was reduced by half or even more in almost 50 percent of the women participating.

In October 2006 the corresponding product became the first oral contraceptive to be approved in the U.S. for treating the emotional and physical symptoms of PMDD. In the meantime the product has also been approved for this indication in Australia and some Latin American and Asian countries.

Advice for patients

Each body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.