title: A randomised comparison over 8 months of 100 micrograms and 200 micrograms twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome.
abstract: OBJECTIVE
  To determine the efficacy of a 100 micrograms twice weekly dose of Estraderm TTS compared with a 200 micrograms dose in the treatment of severe PMS, and to determine the overall acceptability of the treatment. To determine the serum oestradiol levels produced by the two doses of Estraderm and to discover whether the lower dose suppresses ovulation.
  
  
  METHODS
  Main: randomised, prospective, comparative study. Subsidiary: cross-sectional and prospective.
  
  
  METHODS
  Premenstrual syndrome clinic in teaching hospital.
  
  
  METHODS
  Women with severe PMS confirmed by prospective daily symptom recording.
  
  
  METHODS
  Estraderm TTS at a dose of either 100 or 200 micrograms twice weekly continuously with either dydrogesterone 10 mg or medroxyprogesterone acetate 5 mg, from day 17 to day 26 of each cycle.
  
  
  METHODS
  Main: change in total, exponentially smoothed, average maximum score (total-ESAmax) of 10 common premenstrual syndrome symptoms derived from Trigg's trend analysis and patient satisfaction. Subsidiary: plasma oestradiol and day 21 progesterone levels.
  
  
  RESULTS
  Main: no difference in change in total-ESAmax between Estraderm 100 micrograms and 200 micrograms groups. Greater drop-out rate and greater incidence of side effects attributed to oestrogen in higher dosage group. Satisfaction rate of 45% to 57% at eight months. Subsidiary: 1. Mean (95% CI) oestradiol level of 300 pmol/l (255 to 345) with Estraderm 100 micrograms and 573 (494 to 693) with Estraderm 200 micrograms; 2. Estraderm 100 micrograms suppresses mid-luteal progesterone from a mean (95% CI) of 35.5 (28.4 to 42.7) to 3.4 (2.4 to 4.5).
  
  
  CONCLUSIONS
  Estraderm TTS 100 micrograms twice weekly is as effective as 200 micrograms twice weekly in reducing symptom levels in severe premenstrual syndrome but is better tolerated. Estraderm 100 micrograms suppresses ovulation and results in a mean plasma oestradiol level similar to that observed in a spontaneous cycle.
authors.affiliation: Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
authors.forename: R N
authors.initials: RN
authors.lastname: Smith
authors.forename: J W
authors.initials: JW
authors.lastname: Studd
authors.forename: D
authors.initials: D
authors.lastname: Zamblera
authors.forename: E F
authors.initials: EF
authors.lastname: Holland
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D004394:Dydrogesterone / Q000008:administration & dosage; D004958:Estradiol / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate; D010060:Ovulation / Q000187:drug effects; D017060:Patient Satisfaction; D011293:Premenstrual Syndrome / Q000188:drug therapy*; D011372:Progestins / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D011372:Progestins; D004958:Estradiol; D004394:Dydrogesterone; D017258:Medroxyprogesterone Acetate