Priv.-Doz. Dr. med. Martin Sillem

Abstract | CV

The effect of Yasmin® on Premenstrual Symptomatology and Quality of Life

M. Sillem, Dept. of Obstetrics and Gynaecology, Aschaffenburg Academic Hospital

The majority of women experiences adverse symptoms in the second half of their menstrual cycle, with an increasing intensity towards the end of their reproductive phase. These symptoms include bloating, breast tenderness, weight gain, mood swings and food cravings. The intensity varies from mild, well tolerated complaints (premenstrual syndrome, PMS) with an estimated frequency of 66% of cycling women to outright psychiatric morbidity (premenstrual dysphoric disorder, PMDD) which has a prevalence between 3 and 9%. Until recently, a practicable hormonal therapy of these symptoms, albeit clearly hormone dependent, has not been available. Non-hormonal treatments with proven effect include patient reassurance and counselling, vitamin B6, magnesium, and selective serotonin reuptake inhibitors, the latter being effective not only for psychological but also for physical symptoms. 

Drospirenone is a novel 19-nortestosterone derivative with well established progestagenic and antimineralocorticoid effects. 2mg of drospirenone and 30µg of ethinyl estradiol are the active components of the oral contraceptive Yasmin®. In a large prospective post-registration observational study, cycle control, premenstrual symptoms and general well-being were compared in a long cycle administration (63 – 126 days) with a conventional 21-day cycle administration (short cycle).1433 women were observed for 6 months by 152 gynaecologists in private practice, using an online questionnaire. Descriptive comparisons were made using Fisher´s exact test and t-test as applicable. On long cycle treatment (n=175), withdrawal bleedings were similar in duration and intensity compared to short cycle treatment (n=1221). Spottings were observed in 15% on long cycle versus 6% on short cycle. The number of women with breast tenderness at 0/3/6 months of treatment was 37/3/2% of women on long cycle and 25/6/3% of women on short cycle (p<0.05, long versus short cycle). The number of women with abdominal bloating was 24/3/2% of women on long cycle and 18/4/4% of women on short cycle (difference between groups not significant).The number of women with edema was 21/0/1% of women on long cycle and 14/2/1% of women on short cycle (p<0.001). Weight was reduced by 0.57 kg on long cycle (p<0.005) and 0.61 kg on short cycle (p<0.0001). Body mass index was reduced by 0.21kg/m² on long cycle (p=0.0034) and 0.22 kg/m² on short cycle (p<0.0001). General well-being was improved in 85% on long cycle versus 66% on short cycle (p<0.0001). 97% of long cycle users and 91% of short cycle users recommend this preparation for further application. These results in a large group of women confirm previous observations that Yasmin® reduces premenstrual symptoms and improves general well-being. These effects were further increased through long cycle application.

In conclusion, Yasmin®, preferably administered for 63 days continuously, is an effective and well tolerated hormonal treatment for premenstrual symptoms. If necessary, additional non-hormonal therapy can be initiated for the treatment of premenstrual dysphoric disorder.

CV

Priv.-Doz. Dr. med. Martin Sillem graduated from the University of Freiburg Medical School and received his postgraduate training in obstetrics an gynaecology at the Universities of Goettingen and Heidelberg as well as at the Aschaffenburg Academic Hospital, where he is now a consultant gynaecologist and obstetrician. He was also a Visiting Research Fellow at the Jones Institute of Reproductive Medicine in Norfolk, Va. (USA). He is a board approved specialist in gynaecologic endocrinology and reproductive medicine and holds a lectureship at the University of Heidelberg. In 1996, he was awarded the Ludwig Fraenkel Prize of the German Society of Obstetrics and Gynaecolgy. He has a special interest, scientifically as well as clinically, in the subject of endometriosis and therapeutic aspects of contraceptive steroids.