Pj. Magill et al., INVESTIGATION OF THE EFFICACY OF PROGESTERONE PESSARIES IN THE RELIEFOF SYMPTOMS OF PREMENSTRUAL-SYNDROME, British journal of general practice, 45(400), 1995, pp. 589-593
Background A variety of definitions have been applied to premenstrual
syndrome. The severity of the syndrome is also variable. Aim. A study
was undertaken to compare progesterone pessaries with placebo in the r
elief of symptoms of premenstrual syndrome. In this study the conditio
n was characterized by a wide range of symptoms recurring in the late
luteal phase but absent in the follicular phase (that is, the specific
definition published by Dalton in 1953). Method. A multicentre, prosp
ective, double-blind, randomized, parallel group study was undertaken
by 45 general practitioners. Patients were deemed eligible after two p
rospective menstrual cycles of observation (selection phase) in which
a precise definition of symptoms was applied. Patients were randomized
to use either progesterone pessaries (400 mg twice a day) or matching
placebo, by vaginal or rectal administration, from 14 days before the
expected onset of menstruation until the onset of vaginal bleeding, f
or four consecutive cycles. Baseline data for the outcome variables we
re determined in the selection phase. The main outcome variables were
changes in the severity (categorized as none, mild, moderate or severe
) of each patient's most severe symptom, and in the average score of a
ll the patient's symptoms characteristic of premenstrual syndrome. Spo
ntaneous reports of adverse events were recorded. Results. A total of
281 patients were screened for premenstrual syndrome; of these, 141 pa
tients were randomized to treatment or placebo groups. Efficacy was ev
aluated in 93 patients. Reductions in the scores of the highest scorin
g, most severe, symptoms and in the average symptom score, were consis
tently observed in patients receiving progesterone pessaries and in th
ose receiving placebo. The response to progesterone was greater than t
o placebo during each cycle; the differences were clinically and stati
stically significant. Adverse events were reported by 51% of patients
in the progesterone treatment group and by 43% in the placebo group. I
rregularity of menstruation, vaginal pruritus and headache were report
ed more frequently by patients taking active therapy. Conclusion. In t
his study, progesterone, given as pessaries by vaginal or rectal admin
istration, was more effective than placebo in the relief of symptoms o
f premenstrual syndrome in a population of patients selected by strict
entry criteria.