New generation OCPs beneficial for severe PMS

FOURTH-generation oral contraceptive pills (OCPs) should be first-line treatment for severe premenstrual syndrome (PMS) despite the associated risk of venous thromboembolism, an expert says.

Presenting recently at the Australasian Menopause Society Congress in Brisbane, Dr Nick Panay, a gynaecologist at Imperial College London, said the benefits of OCPs in treating severe PMS outweighed the risks.

“We are talking about women who have severe symptoms that are impacting on their quality of life,” he said. 

“In this situation it’s entirely justified to use those pills where what you are looking for are the additional benefits for psychological and physical premenstrual symptoms and not just contraception.”

Dr Panay said women with more severe symptoms, who did not respond to OCPs, could opt for transdermal oestrogen as the next line of therapy.

“For women with the very severest symptoms, the most effective treatment is gonadotrophin-releasing hormone analogues, which can fully suppress their cycle,” he said. “But that has to be used with some additional hormone replacement therapy because you don’t want to replace the PMS symptoms with menopause symptoms.”

PMS treatments needed to be tailored to each patient, he said.

Alternative therapies such as Vitex agnus-castus, red clover and St John’s wort showed promising results in randomised controlled trials but more data were needed.

Data on natural progesterone remained controversial, although many women derived benefit, he said.