- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02427334
Dienogest Versus Luteal Phase Fluoxetine in the Management of Premenstrual Syndrome
Dienogest Versus Luteal Phase Fluoxetine in the Management of Premenstrual Syndrome: A Randomized Double Blind Placebo Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Premenstrual syndrome (PMS) manifests with distressing physical, behavioral and psychological symptoms, in the absence of organic or underlying psychiatric disease, which regularly recur during luteal phase of each menstrual cycle and disappear or significantly improve by the end of menstruation. Approximately 85-90 % of women may experience premenstrual emotional and physical changes in their reproductive age and the prevalence of severe PMS ranges from 3% to 8%.
The etiology of PMS is unknown but cyclical ovarian activity and the effect of estradiol and progesterone on serotonin and gamma-amino butyric acid are key factors. Absence of PMS before puberty, in pregnancy and after the menopause supports a role of cyclical ovarian activity in PMS etiology. PMS symptoms include psychological symptoms like mood swings, irritability, depression and feeling out of control; physical symptoms like breast tenderness, bloating and headaches; and behavioral symptoms like reduced visuospatial and cognitive ability. To diagnose PMS, symptoms should be recorded prospectively over two cycles using a symptom diary. Several symptom diaries exist but the Daily Record of Severity of Problems (DRSP) is reliable and simple for patients.
There is increasing evidence that serotonin may be important in the pathogenesis of PMS. A number of selective serotonin reuptake inhibitors have been used to treat PMS. Fluoxetine at was found to significantly reduce symptoms of tension, irritability and dysphoria, as well as physical symptoms compared with placebo, as measured by visual analogue scales. Luteal phase sertraline was found effective in the management of severe PMS.
Historically, treatment with progesterone was based on the hypothesis that in PMS sufferers, the ratio of progesterone and its derivatives to other hormones was lower than is usual in women. This allowed oestrogens to cause water retention, because there was insufficient progesterone to oppose them.
Gama amino butyric acid (GABA) produced by inhibitory neurons calms symptoms of anxiety, irritability and aggression. Part of the receptors, called GABA(A) on the neurone surface, necessary for GABA to have its effect, cannot be made without the break-down products of progesterone. The occurrence of severe symptoms has been correlated with falling levels of progesterone metabolites. Therefore, progesterone could relieve the symptoms of PMS by preventing falling levels of progesterone metabolites and loss of GABA(A) enhancement.
PMS will be diagnosed prospectively using the DRSP. DRSP is a questionnaire comprised of 25 physical and emotional symptoms including impairment of physical and social activities, women will be asked to give a score of 1 to 6 for each symptom 1 = not at all, 2 = minimal, 3 = mild, 4 = moderate, 5 = severe, 6 = extreme. The investigators will add the symptoms scores of the first day of menses and PMS will be excluded if the score was < 50. If the total score is greater than 50, the patients will record two cycles of symptoms. If more than three items have an average score of more than 3 (mild) during the luteal phase, the investigators will add the scores of five-day intervals during the luteal and follicular phases. PMS will be diagnosed when the luteal phase score is 30 percent greater than the follicular phase score in the 2 months. Women with PMS will be asked to take the drugs for 3 months and keep recording their symptoms and symptom scores will compared to those documented before treatment.
Two hundreds and ten women with premenstrual syndrome will be randomly divided into 3 equal groups using computer generated random numbers. Group 1 will receive oral dienogest (visanne® Bayer, Germany) 2mg for 14 days starting from the 15th day of menstruation, Group 2 will receive fluoxetine (Prozac® Lilly, UK) 20mg and group 3 will receive an oral placebo foe 14 days starting from the 15th day of menstruation.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Cairo, Egypt
- Recruiting
- Cairo University Hospitals
-
Contact:
- AbdelGany Hassan, MRCOG, MD
- Phone Number: 002 01017801604
- Email: abdelgany2@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- PMS
- Consents to the procedure
Exclusion Criteria:
- Previous medical treatment for PMS
- Body mass index > 35 kg/m2
- Irregular periods
- Medical disorders like diabetes, hypertension, cardiac, liver, kidney or heart disease
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Dienogest
women will receive oral dienogest 2mg for 14 days starting from the 15th day of menstruation
|
women will receive oral dienogest 2mg for 14 days starting from the 15th day of menstruation
|
Active Comparator: Fluoxetine
women will receive oral fluoxetine 20mg for 14 days starting from the 15th day of menstruation
|
women will receive oral fluoxetine 20mg for 14 days starting from the 15th day of menstruation
|
Placebo Comparator: Placebo
women will receive oral placebo for 14 days starting from the 15th day of menstruation
|
women will receive oral placebo for 14 days starting from the 15th day of menstruation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improvement of DRSP score
Time Frame: Monthly, up to 3 months
|
DRSP scores will be documented in each treatment month, the mean score will be compared with the pretreatment score
|
Monthly, up to 3 months
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2006 Jan;9(1):41-9. doi: 10.1007/s00737-005-0103-y. Epub 2005 Sep 20.
- Lustyk MK, Widman L, Paschane A, Ecker E. Stress, quality of life and physical activity in women with varying degrees of premenstrual symptomatology. Women Health. 2004;39(3):35-44. doi: 10.1300/J013v39n03_03.
- Smith SS, Gong QH, Hsu FC, Markowitz RS, ffrench-Mullen JM, Li X. GABA(A) receptor alpha4 subunit suppression prevents withdrawal properties of an endogenous steroid. Nature. 1998 Apr 30;392(6679):926-30. doi: 10.1038/31948.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Disease
- Menstruation Disturbances
- Syndrome
- Premenstrual Syndrome
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Psychotropic Drugs
- Serotonin Uptake Inhibitors
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Serotonin Agents
- Antidepressive Agents
- Cytochrome P-450 Enzyme Inhibitors
- Antidepressive Agents, Second-Generation
- Cytochrome P-450 CYP2D6 Inhibitors
- Hormone Antagonists
- Contraceptive Agents, Hormonal
- Contraceptive Agents
- Reproductive Control Agents
- Contraceptives, Oral
- Contraceptive Agents, Female
- Contraceptives, Oral, Hormonal
- Contraceptive Agents, Male
- Fluoxetine
- Dienogest
Other Study ID Numbers
- PMS
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Premenstrual Syndrome
-
Esra ÖZERKTO Karatay UniversityRecruitingPremenstrual Syndrome-PMSTurkey
-
Shaare Zedek Medical CenterUnknownPremenstrual Syndrome-PMS
-
Philipps University Marburg Medical CenterLinkoeping UniversityCompletedPremenstrual Syndrome (PMS)Germany
-
Cairo UniversityNot yet recruitingPremenstrual Tension
-
Cairo UniversityNot yet recruitingPremenstrual Pain
-
Terra Biological LLCCompletedPremenstrual Syndrome (PMS)
-
Massachusetts General HospitalWithdrawnPremenstrual Dysphoric Disorder | Premenstrual Syndrome | Premenstrual Tension | Menstrual Related Mood DisorderUnited States
-
Tel-Aviv Sourasky Medical CenterUnknownDepression | Premenstrual Dysphoric Disorder (PMDD)Israel
-
Yale UniversityNational Institute of Mental Health (NIMH)CompletedPremenstrual SyndromeUnited States
Clinical Trials on Dienogest
-
SanofiCompletedHyperuricemiaKorea, Republic of
-
SanofiCompletedLymphoma | Leukemia | HyperuricemiaJapan
-
Ospedale Policlinico San MartinoCompletedEndometriosis | IVF | Endometriosis OvaryItaly
-
Pharbil Waltrop GmbHCompletedFocus: BioequivalenceGermany
-
BayerCompleted
-
Laboratorios Andromaco S.A.Completed
-
BayerActive, not recruitingEndometriosis Associated Pelvic PainIndia
-
BayerCompleted
-
BayerCompletedEndometriosisKorea, Republic of, Indonesia, Malaysia, Philippines, Singapore, Thailand