Premenstrual Syndromes : PMS and PMDD - Rutuja :: The site ...

44 THE PREMENSTRUAL SYNDROMES
determined by the DSR, and functioning was assessed by
the SDS. The average overall SDS score for both groups
at baseline was 7.25–7.29. The overall SDS score significantly
improved at endpoint compared to baseline with
both escitalopram dosing regimens; there was no significant
difference between the two dosing regimens.
Oral contraceptive trials
Two recently published studies with a new oral contraceptive
containing drospirenone 3 mg and ethinyl estradiol
20 �g administered for three cycles have reported
superior efficacy compared to placebo for premenstrual
symptoms, functioning, and quality of life in women
with PMDD. 74,75 In both studies, PMDD was determined
by prospective DRSP ratings. One of the two
studies was a parallel design study in 449 women. The
DRSP functioning items averaged 3.7–4.2 (out of
maximum possible score of 6) at baseline, and the sum
of Q-LES-Q items 1–14 averaged 57.1–57.9 and overall
life satisfaction score averaged 3. 74 The oral contraceptive
was superior to placebo for the DRSP items of
improved productivity, enhanced enjoyment in social
activities, better quality of relationships, and items 1–14
of the Q-LES-Q. The second study was a crossover
design study in 64 women. The sum of Q-LES-Q items
1–14 averaged 56.6–59.0 at baseline. The oral contraceptive
was superior to placebo for the three DRSP
functioning items (each p � 0.001), items 1–14, and
the overall life satisfaction item of the Q-LES-Q (each
p � 0.04). 75 Previous studies reported that a similar
oral contraceptive with ethinyl estradiol 30 �g improved
premenstrual sense of well-being 76 and improved the
ability to perform usual activities as well as well-being
premenstrually in women. 77 However, neither of these
two latter studies included a formal assessment of PMS
or PMDD in the samples.
A few small and older treatment studies deserve
mention. An open study of fluvoxamine in 10 women
with PMDD demonstrated a 20% improvement in
Q-LES-Q scores after two cycles of treatment, but this was
not statistically significant. 78 A small study comparing 12
sessions of individual cognitive therapy with waitlist in
23 women with prospectively confirmed PMS reported
improvement in total and three SAS factor scores with
cognitive therapy. 79 Cognitive therapy did not improve
marital function compared with the waitlist condition, as
measured by a marital questionnaire. A crossover study
comparing luteal phase alprazolam to placebo in 30
women with late luteal phase dysphoric disorder (now
PMDD) reported social dysfunction in 93% and vocational
functioning in 59% of women at baseline. 80 A significant
improvement in premenstrual social functioning
was reported with alprazolam compared with placebo.
PMDD AND ECONOMIC COST OF
DISEASE BURDEN
Borenstein and colleagues attempted to quantify the
direct and indirect costs associated with PMS in the
non-selected cohort of women enrolled in a medical
group who returned DRSPs described above. 57,58,81 In
addition to daily ratings of symptoms and functioning
items, women were requested to answer three additional
questions daily:
● How many hours did you plan to work today?
● How many hours of work did you miss today due to
health reasons?
● Please rate your level of productivity at work today.
Direct costs can be assessed by the monetary costs for
clinical visits, hospital care, prescription medications,
laboratory tests, and radiological tests. Indirect costs
can be assessed by work absenteeism and lost productivity
at work, or ‘presenteeism’, such as employee errors,
reduced quality, and reduced quantity of work. 81
The most recent study from this research group
assessed direct costs by medical claims and indirect
costs by self-reported days of work missed, number of
hours of intended work on a given day, number of
intended work hours missed, and percentage of the total
possible productivity level for the time worked. 81 From
data available for 374 women, when women with PMS
were compared to those without PMS, having PMS
resulted, on average, in an additional $59 per patient
per year in direct costs and an increase of $4333 in
indirect costs per patient per year based on a 13.7%
absenteeism rate and a 15% reduction in productivity.
Similar to the economic burden with some chronic
medical disorders, the potential economic impact of
PMS was greater from work productivity losses than
direct medical costs. 81
Chawla and colleagues estimated that the cost of
reported lost productivity for 56 women with prospectively
confirmed PMDD was $890 per month in the
studies described above. 4,55 The authors concluded that
the economic burden associated with premenstrual
symptoms was related more to self-reported decreased
productivity than to direct healthcare costs.
CONCLUSION
Studies of prevalence rates of PMDD suggest 3–8% of
menstruating women meet criteria for PMDD and
15–20% of menstruating women meet criteria for subthreshold
PMDD or severe PMS. Several studies suggest
that severity of premenstrual symptoms is associated