Abstract

Premenstrual disorders negatively affect millions of U.S. women. The premenstrual disorder at the most severe end of the spectrum is premenstrual dysphoric disorder (PMDD). The specific diagnostic criteria developed for PMDD and the availability of validated symptom diaries have allowed a more organized study of severe premenstrual disorders. The U.S Food and Drug Administration has now approved 4 agents for the treatment of PMDD: 3 antidepressants (i.e., selective serotonin reuptake inhibitors) and 1 low-dose combination oral contraceptive (COC) that contains the progestin drospirenone and is administered using a regimen of 24 days of active pills in a 28-day cycle (drospirenone/20EE-24/4). Drospirenone is unique among progestins used in COCs in that it has both antimineralocorticoid and antiandrogenic activities. Two pivotal studies have shown drospirenone/20EE-24/4 to be effective in treating the mood, physical and behavioral symptoms of PMDD and symptoms specifically associated with food, water retention and negative interpersonal relationships.