Does progesterone therapy help premenstrual syndrome in women with PCOS?

Introduction: Premenstrual Syndrome (PMS) is defined as a group of disorders characterized by emotional and physical symptoms that occur in the luteal phase of the menstrual cycle and subside following menstruation. The reported prevalence of severe PMS is variable between 3% and 24%. Etiology of PMS remains unknown but cyclical ovarian activity and the effect of estradiol and progesterone on the neurotransmitters serotonin and gamma aminobutyric acid appear to be key factors. One hypothesis that the cause of PMS is the deficiency of progesterone and its derivatives. Polycystic Ovary Syndrome (PCOS) is characterized with chronic anovulation and oligo-ovulation. Due to this there is a distinct deficiency of progesterone and its derivatives in PCOS. The aim of this study was to investigate the efficiency of progesterone therapy for PMS in woman with PCOS. Materials and methods A randomized double blind controlled trial was performed on 60 women with PCOS and PMS. This study was conducted at Holy Family Hospital, Rawalpindi between August 2018 and April 2019. In the study group (progesterone group = group A, n=30), progesteron in a total amount of 300 mg was prescribed for a per day basis on three times a day, and in the control group (placebo group=group B, n=30) placebo capsules, which were completely similar to progesterone capsules were prescribed from day 15 to day 25. The severity and duration of symptoms were compared in both groups before treatment and 3 months after the beginning of treatment with Visual Analog Scala (VAS). Participants were requested to answer questions about their recurrent experience of 16 symptoms during the premenstrual phase. Data were analyzed using the Statistical Package for Social Science. Results: We investigated 60 females (mean age progesterone group / placebo group= 26.6 ± 2,5/ 27 ± 1,8years; range = 18-35 years). Two or more premenstrual symptoms were detected in 95.5% of the participants. The most frequent symptoms are depression, anxiety, abdominal bloating, mood swings, breast tenderness. Statistical significant decline was seen in progesterone treatment group in depression, irritablity, anxiety, mood swing, abdominal bloating, sleeplessness, felt hopeless, breast tenderness, less interest in usual activities symptoms. Conclusion: In this study comparing progesterone therapy with placebo for PMS in women with PCOS, we found that women had much lower depression, irritability, anxiety, mood swing, abdominal bloating, sleeplessness, felt hopeless, breast tenderness, less interest in usual activities symptoms during progesterone treatment.

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