Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review

Katrina Wyatt; Paul Dimmock; Peter Jones; Manjit Obhrai; Shaughn O'Brien

doi:10.1136/bmj.323.7316.776

Therapeutics Hormonal Agents

Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review

Wyatt K, Dimmock P, Jones P, Obhrai M, O'Brien S

Published October 6, 2001 BMJ (Clinical Research Ed.), 323(7316), 776-780

DOI 10.1136/bmj.323.7316.776 PMID 11588078 PMC PMC57352

RRM Academy Synopsis

Progesterone and progestogens gave no clinically important PMS relief

A 2001 review of placebo trials found progesterone and progestogens gave no clinically important relief of premenstrual syndrome. It pooled 10 progesterone trials (531 women) and four progestogen trials (378 women). Every woman had a diagnosis before her trial began.

Key Findings

Across 10 progesterone trials (531 women), the combined odds ratio for improvement over placebo was 1.05 (95% CI 1.03 to 1.08). The authors called this no clinically important difference.
Progesterone suppositories or pessaries had an odds ratio of 0.93 (0.91 to 0.95), marginally favoring placebo. Oral micronized progesterone had an odds ratio of 1.30 (1.25 to 1.36).
The oral micronized result came mainly from one trial of 170 women. That trial's own authors concluded that oral micronized progesterone therapy was no better than placebo.
Four progestogen trials (378 women) gave an odds ratio of 1.07 (1.03 to 1.11), which the authors described as statistically but not clinically significant.
The authors set oral micronized progesterone at 1.3 beside 6.91 for selective serotonin reuptake inhibitors (SSRIs), taken from another meta-analysis that used the same inclusion criteria.

Interpretation

This review pooled placebo trials. Every woman's premenstrual syndrome was diagnosed before her trial began. The authors note that no trials tested progesterone cream. The findings support larger trials of progesterone and progestogens for premenstrual syndrome.

RRM Context

Progesterone and progestogens are different drugs. The review reports them apart. The authors note that premenstrual syndrome occurs in ovulatory cycles. Past studies found the same progesterone levels in women with and without it. Restorative reproductive medicine treats these symptoms as a sign tied to the cycle, and evaluates before it treats.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To evaluate the efficacy of progesterone and progestogens in the management of premenstrual syndrome.

Design

Systematic review of published randomised, placebo controlled trials.

Studies Reviewed

10 trials of progesterone therapy (531 women) and four trials of progestogen therapy (378 women).

Main Outcome Measures

Proportion of women whose symptoms showed improvement with progesterone preparations (suppositories and oral micronised). Proportion of women whose symptoms showed improvement with progestogens. Secondary analysis of efficacy of progesterone and progestogens in managing physical and behavioural symptoms.

Results

Overall standardised mean difference for all trials that assessed efficacy of progesterone (by both routes of administration) was -0.028 (95% confidence interval -0.017 to -0.040). The odds ratio was 1.05 (1.03 to 1.08) in favour of progesterone, indicating no clinically important difference between progesterone and placebo. For progestogens the overall standardised mean was -0.036 (-0.014 to -0.060), which corresponds to an odds ratio of 1.07 (1.03 to 1.11) showing a statistically, but not clinically, significant improvement for women taking progestogens.

Conclusion

The evidence from these meta-analyses does not support the use of progesterone or progestogens in the management of premenstrual syndrome.

Topics

Therapeutics › Hormonal Agents › Progesterone and Progestins · Menstrual Cycle › Premenstrual Disorders › Premenstrual Syndrome Treatment · Reproductive Endocrinology › Ovarian Hormones › Progesterone

Katrina Wyatt, Paul Dimmock, Peter Jones, Manjit Obhrai, Shaughn O'Brien

K Wyatt, P Dimmock, Pete Jones, P Jones, M Obhrai, S O'Brien

PMID 11588078 11588078 DOI 10.1136/bmj.323.7316.776 10.1136/bmj.323.7316.776 Wyatt et al. 2001, Wyatt 2001

Keywords

Female, Humans, Odds Ratio, Premenstrual Syndrome/drug Therapy, Progesterone/therapeutic Use, Progestins/therapeutic Use, Randomized Controlled Trials As Topic, Treatment Outcome, Progestins, Progesterone

Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review

Progesterone and progestogens gave no clinically important PMS relief

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review

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Keywords