Second Chapter
Dr. Álvaro Monterrosa Castro, MD
Etiology of premenstrual syndrome
There is still no conclusive data on the etiology of premenstrual syndrome, the pathophysiology is not precisely known and there is no specific explanation for the diversity of events that occur.
Premenstrual syndrome that occurs 7 to 10 days before the start of the period is characterized by the presence of affective symptoms such as: depression, anger attacks, irritability, anxiety, confusion or social withdrawal, and by somatic symptoms such as: mastalgia, breast tension, abdominal swelling, headache and edema of the extremities.
To diagnose premenstrual syndrome, at least one of the affective manifestations and one of the somatic manifestations must be present.
The condition stops with the onset of menstruation and affects a considerable number of women during their childbearing years.
Premenstrual syndrome is less common among oral contraceptive users than among non-users (82), although it has not been conclusively shown to reduce the incidence or severity of a different pathology called premenstrual dysphoric syndrome (43).
A randomized study has recently been published to compare the effect on premenstrual symptoms of a pill with 30 ug/day of ethinyl estradiol plus 3 mg/day of drospirenone and another with 30 ug/day of ethinyl estradiol plus 150 ug/day of levonorgestrel. after six cycles of treatment. Symptoms were measured using the Women’s Health Assessment Questionnaire.
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At the end of the study, users of the combination pill containing drospirenone:
They had fewer premenstrual symptoms in all parameters than those who received the combined levonorgestrel pill, therefore the former may be an important recommendation for women susceptible to the manifestations of premenstrual syndrome (116). Borenstein et al (115) analyzed 858 questionnaires from women who used 30 ug/day of ethinyl estradiol plus 3 mg/day of drospirenone.
The majority of the participants (72%) reported having premenstrual syndrome and half used different strategies to alleviate them. 35% used over-the-counter drugs, 11% used different herbs, and 10% used prescription medications.
Significant improvement was observed in water and saline retention, and in negative affective aspects. Both the disability linked to daily activity and the sense of well-being improved from the beginning of the study to the end of treatment.
The data support the effectiveness of this pill in reducing the symptoms of premenstrual syndrome, contributing to improving quality of life. In his short review article, Oelkers (63) points out that drospirenone has a favorable effect on premenstrual syndrome.
Dr. Álvaro Monterrosa Castro, MD
