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Combined oral contraceptives containing drospirenone ‘should be first-line for PMS’

The Royal College of Obstetricians and Gynaecologists have produced new guidelines for premenstrual syndrome, advising that combined oral contraceptives containing drospirenone should be considered as a first-line treatment.

The RCOG guidelines, an update on 2007 recommendations, suggest that there is strong evidence for drospirenone-containing COCs being more effective at reducing the severity of PMS symptoms than COCs containing other progestogen alternatives.

This clarifies the 2007 guidance which states that although drospirenone-containing COCs may be effective, the evidence base for this claim remains small.

Oral progestogen has also been replaced with micronised progesterone for progestogenic opposition when prescribing oestrogen to treat PMS, as it is less likely to reintroduce PMS-like symptoms. 

‘Micronised oral progesterone (100 or 200mg) has fewer androgenic and unwanted adverse effects compared with progestogens such as norethisterone and levonorgestrel,’ say the RCOG.

The new guidelines take a harder stance on the benefits of complementary medicine than the old, saying that ‘there is conflicting evidence to support the use of some complementary medicines’ and citing several studies with inconclusive low-power data to support this.

This is in comparison to the 2007 guidelines, which conclude that ‘although many complementary therapies for PMS are not evidence based, it is generally agreed among health professionals treating women with PMS that an integrated approach is beneficial for the majority of patients.’