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Prevalence of psychiatric disorders and premenstrual dysphoric symptoms in patients with experience of adverse mood during treatment with combined oral contraceptives
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Reproduktiv hälsa/Sundström Poromaa)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
Dept of Clinical Science, Obstetrics and Gynecology, Umeå University, Sweden.
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2009 (English)In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 79, no 1, 50-55 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Negative mood symptoms remain one of the major reasons for discontinuation of combined oral contraceptive pills (COCs). The primary aim of this study was to compare the prevalence of mood and anxiety disorders in women with different experience of COCs. STUDY DESIGN: Thirty women currently on COCs with no report of adverse mood symptoms, 28 women currently on COCs and experiencing mood-related side effects, 33 women who had discontinued COC use due to adverse mood effects and 27 women who had discontinued COC use for reasons other than adverse mood symptoms were included. Ongoing psychiatric disorders were evaluated by a structured psychiatric interview and prevalence rates of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) were assessed by daily prospective ratings on the Cyclicity Diagnoser scale. RESULTS: Women with ongoing or past experience of COC-induced adverse mood, more often suffered from mood disorders than women with no reports of adverse mood while on COC. The prevalence of prospectively defined PMS or PMDD did not differ between prior users with positive or negative experience. Women who had discontinued COC use due to adverse mood symptoms more often had had a legal abortion in the past. CONCLUSION: Women with ongoing or past self-reported adverse mood effects from COCs had a significantly increased prevalence of mood disorders.

Place, publisher, year, edition, pages
2009. Vol. 79, no 1, 50-55 p.
Keyword [en]
Combined oral contraceptive pills, Estrogen, Progestogen, Depression, Anxiety, Premenstrual syndrome, Premenstrual dysphoric disorder
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-98210DOI: 10.1016/j.contraception.2008.08.001ISI: 000261721000008PubMedID: 19041441OAI: oai:DiVA.org:uu-98210DiVA: diva2:173909
Available from: 2009-02-18 Created: 2009-02-17 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Is it Just the Hormones?: Sex Steroids, Chronic Stress and Violence in Premenstrual Dysphoric Disorder
Open this publication in new window or tab >>Is it Just the Hormones?: Sex Steroids, Chronic Stress and Violence in Premenstrual Dysphoric Disorder
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Premenstrual depressive symptoms and mood swings affect 3-8% of women in fertile age. The female hormones are believed to be the cause. Progesterone is well studied, but estrogen is not, and either are other causes such as intimate partner violence and chronic stress.

The aim in this thesis was to investigate the influence of hormones as well as psychological aspects on the most common problems among women seeking care for premenstrual symptoms.

In a cross-sectional study, four groups of women were included: ongoing users of oral contraceptives, with or without adverse mood symptoms and previous users, with or without experience of adverse mood. Depression and anxiety were significantly more common in both groups with reported adverse mood, in comparison with their control groups with no adverse mood. Self-reported PMS was significantly more common in those women who reported adverse mood, however, there was no difference in prospectively defined PMS or PMDD between the two groups of previous users.

In a RCT with 25 women completing the study, GnRH treatment were tested in combination with two different HRT add-back doses of estradiol, in combination with progesterone and placebo. The higher dose of estrogen 1.5 mg in combination with progesterone induced significantly more pronounced symptoms than in combination with placebo. The lower dose, 0.5 mg gave less symptom recurrence in combination with progesterone.

Exposure to violence was investigated among PMDD patients, healthy controls and gynecological patients. Among the participating women, gynecological patients, reported physical and/or emotional abuse significantly more often than did PMDD patients, as well as healthy controls.

Chronic stress was investigated with diurnal cortisol, and low-dose dexamethasone test.  There was no difference in diurnal secretion of cortisol between PMDD patients and controls. No difference in the degree of dexamethasone suppression was found between PMDD patients and controls.

According to the results from these studies, the main symptom provoking factor in women with PMDD appears to be the estradiol and progesterone fluctuations across the menstrual cycle, whereas chronic stress and intimate partner violence appears to be less relevant.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 642
Keyword
premenstrual dysphoric disorder; combined oral contraceptive; GnRH agonist; add-back; estradiol; progesterone; chronic stress; intimate partner violence; depression, anxiety; allopregnanolone
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-145384 (URN)978-91-554-8004-2 (ISBN)
Public defence
2011-03-25, Rosénsalen, Akademiska Sjukhuset Ing 95/96, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-03-04 Created: 2011-02-08 Last updated: 2011-05-04

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