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Эффективность лечения тяжелого предменструального синдрома дроспиренонсодержащим препаратом
Эффективность лечения тяжелого предменструального синдрома дроспиренонсодержащим препаратом
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Аннотация
Женщины в большей степени, чем мужчины, страдают от разных психических нарушений. Одними из таких расстройств могут быть предменструальный синдром (ПМС) и предменструальное дисфорическое расстройство, как правило, связанные с нарушением функции гипоталамо-гипофизарно-яичниковой системы. Назначение комбинированных гормональных контрацептивов является патогенетически обоснованным методом лечения этих патологических состояний.
В проведенном исследовании диагноз «тяжелый ПМС» был подтвержден проспективной оценкой ПМС-дневников. Препарат, содержащий 3 мг дроспиренона и 20 мкг этинилэстрадиола в режиме 24/4, получали 120 пациенток. Оценка эффективности лечения проводилась по изменению средних суммарных показателей ПМС-дневников в течение 2 мес до и 3 мес в процессе лечения.
Результат: выявлено уменьшение выраженности симптомов на фоне лечения: до начала средний балл составил 34,8; через 1 мес –22,5, а через 3 мес лечения – 15,1. Неблагоприятные явления, зарегистрированные у 26 пациенток (21,7%), были расценены как незначительные. Две пациентки (1,7%) прекратили прием препарата в связи с неблагоприятными явлениями. Продолжили и полностью завершили лечение 117 женщин.
Заключение. Исследование показало высокую эффективность и приемлемость микродозированного дроспиренонсодержащего КОК в режиме 24/4 при лечении женщин с тяжелым ПМС.
Ключевые слова: контрацепция, дроспиренон, ПМС, предменструальное дисфорическое расстройство.
Appointment of combined hormonal contraceptives (COC) ispathogenetically substantiated treatment of these pathologiesIn the study, diagnosis of severe PMS was confirmed by a prospective evaluation of PMS-diarys. Combined oral contraceptives containing 3 mg drospirenene and 20µg ethinylestradiol administered in a 24/4 regimen were prescribed to 120 patients with heavy PMS. Assessment of the effectiveness of the treatment was carried out according to the change in average total PMS-diaries score for two months before and three months in the course of the treatment.
Result. Revealed a decrease in symptoms during treatment: Prior to the average score was 34.8, after 1 month of -22.5 points, and after 3 months of treatment -15,1 points. Adverse events were recorded in 26 patients (21.7%) and were regarded as minor. Two patients (1.7%) discontinued the drug due to adverse events. 117 women continued and completed the treatment.
Conclusion. The study showed high efficacy and acceptability drospirenone-containing COCs in a 24/4 for the treatment of women with severe PMS.
Key words: contraception, drospirenone, PMS, premenstrual dysphoric disorder.
В проведенном исследовании диагноз «тяжелый ПМС» был подтвержден проспективной оценкой ПМС-дневников. Препарат, содержащий 3 мг дроспиренона и 20 мкг этинилэстрадиола в режиме 24/4, получали 120 пациенток. Оценка эффективности лечения проводилась по изменению средних суммарных показателей ПМС-дневников в течение 2 мес до и 3 мес в процессе лечения.
Результат: выявлено уменьшение выраженности симптомов на фоне лечения: до начала средний балл составил 34,8; через 1 мес –22,5, а через 3 мес лечения – 15,1. Неблагоприятные явления, зарегистрированные у 26 пациенток (21,7%), были расценены как незначительные. Две пациентки (1,7%) прекратили прием препарата в связи с неблагоприятными явлениями. Продолжили и полностью завершили лечение 117 женщин.
Заключение. Исследование показало высокую эффективность и приемлемость микродозированного дроспиренонсодержащего КОК в режиме 24/4 при лечении женщин с тяжелым ПМС.
Ключевые слова: контрацепция, дроспиренон, ПМС, предменструальное дисфорическое расстройство.
________________________________________________
Appointment of combined hormonal contraceptives (COC) ispathogenetically substantiated treatment of these pathologiesIn the study, diagnosis of severe PMS was confirmed by a prospective evaluation of PMS-diarys. Combined oral contraceptives containing 3 mg drospirenene and 20µg ethinylestradiol administered in a 24/4 regimen were prescribed to 120 patients with heavy PMS. Assessment of the effectiveness of the treatment was carried out according to the change in average total PMS-diaries score for two months before and three months in the course of the treatment.
Result. Revealed a decrease in symptoms during treatment: Prior to the average score was 34.8, after 1 month of -22.5 points, and after 3 months of treatment -15,1 points. Adverse events were recorded in 26 patients (21.7%) and were regarded as minor. Two patients (1.7%) discontinued the drug due to adverse events. 117 women continued and completed the treatment.
Conclusion. The study showed high efficacy and acceptability drospirenone-containing COCs in a 24/4 for the treatment of women with severe PMS.
Key words: contraception, drospirenone, PMS, premenstrual dysphoric disorder.
Полный текст
Список литературы
1. Аганезова Н.В. Ассоциация функциональных вариантов генов транспортеров серотонина и дофамина с психовегетативными нарушениями у больных с предменструальным синдромом. VII Всероссийская научно-практическая конференция с международным участием «Молекулярная диагностика – 2010». Сб. тр. Под ред. В.И.Покровского. 2010; т. 3 (разд. 13): 4, 5.
2. Прилепская В.Н., Межевитинова Е.А. Предменструальный синдром. Гинекология. 2005; 7 (4): 210–4.
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4. Andréen L et al. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology 2009; 34 (8): 1121–32.
5. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci 2011; 32: S31–5.
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7. Halbreich U et al. Premenstrual changes and changes in gonadal hormones. Acta Psychiatr Scand 1986; 74 (6): 576–86.
8. Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol 1994; 170 (5 Pt 2): 1499–507.
9. Machado RB et al. Drospirenone/ethinylestradiol: a review on efficacy and noncontraceptive benefits. Womens Health (Lond Engl) 2011; 7 (1): 19–30.
10. Marr J et al. Ethinyl estradiol 20μg/drospirenone 3mg 24/4 oral contraceptive for the treatment of functional impairment in women with premenstrual dysphoric disorder. Int J Gynaecol Obstet 2011; 113 (2): 103–7.
11. Mishell DR. YAZ and the novel progestin drospirenone. J Reprod Med 2008; 53 (Suppl. 9): 721–8.
12. O'Brien PM et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14 (1): 13–21.
13. OelkersW. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Mol Cell Endocrinol 2004; 217 (1–2): 255–61.
14. Oinonen K, Mazmanian D. To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002; 70 (3): 229–40.
15. Parsey KS, Pong A. An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception 2000; 61 (2): 105–11.
16. Pearlstein TB et al. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation Contraception 2005; 72 (6): 414–21.
17. Pinkerton JV. The menstrual cycle–mood disorder tandem: Screening, diagnosis, and treatment. OBG Management 2011; 23 (12): 24–9.
18. Rapkin AJ et al. Oral contraceptives and neuroactive steroids. Pharmacol Biochem Behav 2006; 84 (4): 628–34.
19. Sangthawan M, Taneepanichskul S. A comparative study of monophasic oral contraceptives containing either drospirenone 3 mg or levonorgestrel 150 microg on premenstrual symptoms. Contraception 2005; 71 (1): 1–7.
20. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol 2000; 15 (Suppl. 3): S5–17.
21. Usman SB et al. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2008; 22 (2): 251–60.
22. Yonkers KA et al. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005; 106 (3): 492–501.
2. Прилепская В.Н., Межевитинова Е.А. Предменструальный синдром. Гинекология. 2005; 7 (4): 210–4.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Press, 1994.
4. Andréen L et al. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology 2009; 34 (8): 1121–32.
5. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci 2011; 32: S31–5.
6. Freeman EW, Sondheimer SJ. Premenstrual dysphoric disorder: recognition and treatment. Primary Care Companion. J Clin Psychiatry 2003; 5: 30–9.
7. Halbreich U et al. Premenstrual changes and changes in gonadal hormones. Acta Psychiatr Scand 1986; 74 (6): 576–86.
8. Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol 1994; 170 (5 Pt 2): 1499–507.
9. Machado RB et al. Drospirenone/ethinylestradiol: a review on efficacy and noncontraceptive benefits. Womens Health (Lond Engl) 2011; 7 (1): 19–30.
10. Marr J et al. Ethinyl estradiol 20μg/drospirenone 3mg 24/4 oral contraceptive for the treatment of functional impairment in women with premenstrual dysphoric disorder. Int J Gynaecol Obstet 2011; 113 (2): 103–7.
11. Mishell DR. YAZ and the novel progestin drospirenone. J Reprod Med 2008; 53 (Suppl. 9): 721–8.
12. O'Brien PM et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14 (1): 13–21.
13. OelkersW. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Mol Cell Endocrinol 2004; 217 (1–2): 255–61.
14. Oinonen K, Mazmanian D. To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002; 70 (3): 229–40.
15. Parsey KS, Pong A. An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception 2000; 61 (2): 105–11.
16. Pearlstein TB et al. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation Contraception 2005; 72 (6): 414–21.
17. Pinkerton JV. The menstrual cycle–mood disorder tandem: Screening, diagnosis, and treatment. OBG Management 2011; 23 (12): 24–9.
18. Rapkin AJ et al. Oral contraceptives and neuroactive steroids. Pharmacol Biochem Behav 2006; 84 (4): 628–34.
19. Sangthawan M, Taneepanichskul S. A comparative study of monophasic oral contraceptives containing either drospirenone 3 mg or levonorgestrel 150 microg on premenstrual symptoms. Contraception 2005; 71 (1): 1–7.
20. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol 2000; 15 (Suppl. 3): S5–17.
21. Usman SB et al. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2008; 22 (2): 251–60.
22. Yonkers KA et al. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005; 106 (3): 492–501.
2. Прилепская В.Н., Межевитинова Е.А. Предменструальный синдром. Гинекология. 2005; 7 (4): 210–4.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Press, 1994.
4. Andréen L et al. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology 2009; 34 (8): 1121–32.
5. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci 2011; 32: S31–5.
6. Freeman EW, Sondheimer SJ. Premenstrual dysphoric disorder: recognition and treatment. Primary Care Companion. J Clin Psychiatry 2003; 5: 30–9.
7. Halbreich U et al. Premenstrual changes and changes in gonadal hormones. Acta Psychiatr Scand 1986; 74 (6): 576–86.
8. Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol 1994; 170 (5 Pt 2): 1499–507.
9. Machado RB et al. Drospirenone/ethinylestradiol: a review on efficacy and noncontraceptive benefits. Womens Health (Lond Engl) 2011; 7 (1): 19–30.
10. Marr J et al. Ethinyl estradiol 20μg/drospirenone 3mg 24/4 oral contraceptive for the treatment of functional impairment in women with premenstrual dysphoric disorder. Int J Gynaecol Obstet 2011; 113 (2): 103–7.
11. Mishell DR. YAZ and the novel progestin drospirenone. J Reprod Med 2008; 53 (Suppl. 9): 721–8.
12. O'Brien PM et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14 (1): 13–21.
13. OelkersW. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Mol Cell Endocrinol 2004; 217 (1–2): 255–61.
14. Oinonen K, Mazmanian D. To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002; 70 (3): 229–40.
15. Parsey KS, Pong A. An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception 2000; 61 (2): 105–11.
16. Pearlstein TB et al. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation Contraception 2005; 72 (6): 414–21.
17. Pinkerton JV. The menstrual cycle–mood disorder tandem: Screening, diagnosis, and treatment. OBG Management 2011; 23 (12): 24–9.
18. Rapkin AJ et al. Oral contraceptives and neuroactive steroids. Pharmacol Biochem Behav 2006; 84 (4): 628–34.
19. Sangthawan M, Taneepanichskul S. A comparative study of monophasic oral contraceptives containing either drospirenone 3 mg or levonorgestrel 150 microg on premenstrual symptoms. Contraception 2005; 71 (1): 1–7.
20. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol 2000; 15 (Suppl. 3): S5–17.
21. Usman SB et al. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2008; 22 (2): 251–60.
22. Yonkers KA et al. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005; 106 (3): 492–501.
________________________________________________
2. Прилепская В.Н., Межевитинова Е.А. Предменструальный синдром. Гинекология. 2005; 7 (4): 210–4.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Press, 1994.
4. Andréen L et al. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology 2009; 34 (8): 1121–32.
5. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci 2011; 32: S31–5.
6. Freeman EW, Sondheimer SJ. Premenstrual dysphoric disorder: recognition and treatment. Primary Care Companion. J Clin Psychiatry 2003; 5: 30–9.
7. Halbreich U et al. Premenstrual changes and changes in gonadal hormones. Acta Psychiatr Scand 1986; 74 (6): 576–86.
8. Lobo RA, Stanczyk FZ. New knowledge in the physiology of hormonal contraceptives. Am J Obstet Gynecol 1994; 170 (5 Pt 2): 1499–507.
9. Machado RB et al. Drospirenone/ethinylestradiol: a review on efficacy and noncontraceptive benefits. Womens Health (Lond Engl) 2011; 7 (1): 19–30.
10. Marr J et al. Ethinyl estradiol 20μg/drospirenone 3mg 24/4 oral contraceptive for the treatment of functional impairment in women with premenstrual dysphoric disorder. Int J Gynaecol Obstet 2011; 113 (2): 103–7.
11. Mishell DR. YAZ and the novel progestin drospirenone. J Reprod Med 2008; 53 (Suppl. 9): 721–8.
12. O'Brien PM et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14 (1): 13–21.
13. OelkersW. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Mol Cell Endocrinol 2004; 217 (1–2): 255–61.
14. Oinonen K, Mazmanian D. To what extent do oral contraceptives influence mood and affect? J Affect Disord 2002; 70 (3): 229–40.
15. Parsey KS, Pong A. An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception 2000; 61 (2): 105–11.
16. Pearlstein TB et al. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation Contraception 2005; 72 (6): 414–21.
17. Pinkerton JV. The menstrual cycle–mood disorder tandem: Screening, diagnosis, and treatment. OBG Management 2011; 23 (12): 24–9.
18. Rapkin AJ et al. Oral contraceptives and neuroactive steroids. Pharmacol Biochem Behav 2006; 84 (4): 628–34.
19. Sangthawan M, Taneepanichskul S. A comparative study of monophasic oral contraceptives containing either drospirenone 3 mg or levonorgestrel 150 microg on premenstrual symptoms. Contraception 2005; 71 (1): 1–7.
20. Steiner M, Born L. Diagnosis and treatment of premenstrual dysphoric disorder: an update. Int Clin Psychopharmacol 2000; 15 (Suppl. 3): S5–17.
21. Usman SB et al. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2008; 22 (2): 251–60.
22. Yonkers KA et al. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005; 106 (3): 492–501.
Авторы
А.В.Ледина, В.Н.Прилепская
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздравсоцразвития РФ
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздравсоцразвития РФ
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