Progesterone Transdermal Gel in the Treatment of Premenstrual Dysphoric
Disorder
James L. Schaller, MD, MAR
Chester County Research Center
West Chester, Pennsylvania
Ben Briggs, RPh
Michael Briggs, PharmD
Lionville Pharmacy, Lionville,
Pennsylvania
Premenstrual dysphoric disorder (PMDD) is characterized
by dysphoria (depressed or labile mood, anxiety, tension, irritability)
that occurs during the last week of the luteal phase of the menstrual
cycle. The distinguishing feature of PMDD is the cyclical nature
of the symptoms that it produces. The symptoms of PMDD are similar
in severity to those of major depressive episode or a generalized
anxiety disorder. The cause of PMDD is difficult to identify, in
part because of the interrelated effects of hormones, neurotransmitters,
carrier proteins, stress, and nutrition. This disorder can markedly
interfere with work or with school or social functioning.(1)
Progesterone exerts a less potent physiologic effect
than that of the synthetic progestins in oral contraceptives(2).
The action of progesterone is complex, it affects the levels of
serotonin and gamma-aminobutyric acid, and other neurotransmitters(3).
Micronized progesterone (Prometrium) in 100-mg and 200-mg capsules
is the only commercially available oral progesterone (4). However,
we use transdermal gels (5) in the treatment of adolescent PMDD
for the following reasons: Prometrium, which is synthesized from
a plant source, contains peanut oil that can cause an anaphylactic
response,(4) and the smallest dose available (100 mg) is 4 times
the dosage we have found to be effective in our patients. In this
article, we report the successful use of a rapidly absorbed progesterone
transdermal gel in preventing or resolving the symptoms of PMDD
in two of our adolescent patients.
Case 1
An 18-year-old adolescent who experienced menarche at the aae of
13 became our patient when she was 16 years of age. At the time
of this writing, her weight and height are normal for her age, and
her menstrual cycle ranges from 28 to 30 days. Three days before
she menstruates, this patient regularly experiences the spectrum
of diagnostic criteria for PMDD: irritability, lability, lethargy,
changes in sleep patterns and appetite, bloating, and migraine.
The administration of a progesterone transdermal gel 50 mg/0.1 mL
was prescribed at 25 mg (0.05 mL) to be applied twice daily (morning
and night) to the dorsal side of one hand. This treatment results
in the complete resolution of the symptoms of PMDD for this patient.
Case 2
A thin (body fat, 15%) adolescent treated by our practice experienced
menarche at the age of 14 1/2 years. Probably as a result of insufficient
body fat and a low level of estrone, she menstruates only every
2 to 3 months but experiences the symptoms of PMDD during every
month in which she menstruates. Now, 5 to 7 days before the estimated
date of menstruation and/or "when she feels her symptoms worsening,"
she applies 25 mg (0.05 mL) of progesterone transdermal gel 50 mg/0.1
mL daily (morning and night) to the dorsal side of one hand. The
symptoms of PMDD resolve completely with this treatment.
References
1. [No author listed.] Premenstrual dysphoricdisorder: Diagnosis
and prognosis. Available at: http:// www.psychiatrymatters.md. Accessed
2/14/2002.
2. Lachelin GG. Introduction to Clinical Reproductive Endocrinology.
London: ButterworthHeinemann; 1991:182-183.
3. Yen SSC. Chronic anovulation due to CNS-hypothalamic-pituitary
dysfunction. In: Reproductive Endocrinology: Physiology, Pathophysiology,
and Clinical Management. Philadelphia: Saunders; 1999:516-561.
4. Olin B, ed. Drug Facts and Comparisons. St. Louis, MO: Facts
and Comparisons; 2002:230.
5. Willimann H, Walde P, Luisi PL, et al. Lecithin transdermal gel
as matrix for transdermal transport of drugs. J Pharm Sci 1992;81:871-874.
excerpt from RXTriad, April 2002
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