Suppression of ovulation by transdermal oestradiol patches.

Watson, Neil V.; Studd, J. W. W.; Riddle, Andrew; Savvas, M.

doi:10.1136/bmj.297.6653.900

Cited by 21 publications

(10 citation statements)

References 6 publications

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“…The observation that E1G mood sensitivity strength is most predictive of depressive symptoms among women who are still experiencing frequent menstrual cycles is consistent with our previous report that the prophylactic mood benefits of 12 months of transdermal estradiol, presumably stabilizing estradiol levels (Watson, Studd, Riddle, & Savvas, 1988), are greater among early perimenopausal women relative to late perimenopausal women (Gordon et al, 2018). However, the finding that E1G sensitivity strength was less predictive of depressive symptoms among women already at high risk for depressionthat is, women reporting more baseline stressful life events and a prior history of major depressive disordercontradicts our previous finding that women with a higher number of stressful life events experience greater mood benefits of transdermal estradiol (Gordon et al, 2018).…”

Section: Discussionsupporting

confidence: 91%

Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition

et al. 2020

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Background The risk for depression markedly rises during the 5–6 years leading up to the cessation of menstruation, known as the menopause transition. Exposure to extreme estradiol levels may help explain this increase but few studies have examined individual sensitivity to estradiol in predicting perimenopausal depression. Method The current study recruited 101 perimenopausal women. During Phase 1, we quantified each woman's sensitivity to changes in estradiol using 12 weekly measures of estrone-3-glucuronide (E1G), a urinary metabolite of estradiol, and concurrent depressive symptoms. The weekly cortisol awakening response was measured to examine the hypothalamic-pituitary-adrenal (HPA) axis in mediating mood sensitivity to estradiol. In Phase 2, depressive symptoms and major depression diagnoses were assessed monthly for 9 months. The relationship between Phase 1 E1G sensitivity and Phase 2 depressive symptoms and major depressive episodes was examined. Several baseline characteristics were examined as potential moderators of this relationship. Results The within-person correlation between weekly E1G and mood varied greatly from woman to woman, both in strength and direction. Phase 1 E1G mood sensitivity predicted the occurrence of clinically significant depressive symptoms in Phase 2 among certain subsets of women: those without a prior history of depression, reporting a low number of baseline stressful life events, and reporting fewer months since their last menstrual period. HPA axis sensitivity to estradiol fluctuation did not predict Phase 2 outcomes. Conclusion Mood sensitivity to estradiol predicts risk for perimenopausal depression, particularly among women who are otherwise at low risk and among those who are early in the transition.

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Section: Discussionsupporting

confidence: 91%

Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition

et al. 2020

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“…There was a remarkably high placebo response, with 94 % of the placebo group showing improvement during the first 2 months. This dose had been shown to suppress ovulation in a previous study (Watson et al 1988), but the effectiveness, or otherwise, of lower doses in suppressing ovulation was not reported. The long-term effects of the considerable amount of oestradiol that is administered to young cycling women with such treatment are not known.…”

Section: (F) Oestrogen Implants and Patchesmentioning

confidence: 89%

The premenstrual syndrome – a reappraisal of the concept and the evidence

Bancroft¹

1993

Psychol. Med. Monogr. Suppl.

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Request Permissions : Click here Downloaded from http://journals.cambridge.org/PMS, IP address: 216.165.126.139 on 12 Apr 2015 SYNOPSIS The Premenstrual Syndrome (PMS) remains a controversial issue. As a clinical concept it is surrounded by confusion. Attempts to establish a consensus definition have resulted in the majority of women seeking help for such problems excluded from the diagnosis. Furthermore, there is no consensus about how such problems should be treated, with a variety of methods being advocated usually on very uncertain scientific grounds. The issue also has its political implications; there are those who see PMS as a way of reducing the status of women, by linking the normal ovarian cycle to a phenomenon which, on the face of it, impairs women's ability to cope. Yet there are a substantial number of women who experience significant negative changes which vary with the menstrual cycle, and produce long-term effects on their well being and family relationship which can be serious. There is also a real possibility that recurrent perimenstrual mood changes of this kind may increase the likelihood of chronic depressive illness in susceptible individuals. In most respects the features of depression which occurs perimenstrually are essentially similar to those of major depressive disorder, except for the short duration and recurrent pattern.PMS, therefore, remains an issue not only of clinical importance, but of considerable potential relevance to our understanding of major depressive disorder, which is substantially more common in women of reproductive age than in their male counterparts.In this review the concept of PMS, and some prominent operational definitions of it, are critically evaluated; it is now questionable whether the concept, as currently applied, still carries any heuristic or clinical value. Some current theoretical and aetiological issues are considered: e.g. the role of the corpus luteum, the effects of hormonal regimes which block ovulation, such as oral contraceptives, and the possibility that cyclical mood change represents an entrained rhythm in the brain.The conclusions reached at this stage in the review lead to a ' paradigm shift' with the proposal of a three-factor model to account for the complexities of menstrual cycle-related problems. These three factors are (a) the 'timing factor', imposed by the ovarian hormonal cycle, and possibly accounting for cyclical changes in CNS neurotransmitter activity; (b) a 'menstruation factor', including the processes involved in the build up as well as shedding of the endometrium and the ways in which these processes might adversely affect the women's well being both premenstrually as well as during menstruation; and (c) the 'vulnerability factor', covering a variety of characteristics, constitutional as well as situational, psychosocial as well as biological, which are not in themselves functions of the menstrual cycle but which serve to determine how vulnerable a woman will be to the first two factors.The relevant evidence in the litera...

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“…17β‐oestradiol also may be administered by transdermal patch, a route which has the advantage of being readily discontinued. Initial work indicated that a dose of 200 μg twice weekly of Estraderm TTS® (CIBA Laboratories, Horsham, West Sussex) suppresses ovulation (Watson et al 1988), and this dose was subsequently tested against placebo and found to be highly effective (Watson et al 1989), reducing both the physical and psychological symptoms of PMS by an average of 60%. Despite this efficacy there is concern that 200 μg twice weekly of Estraderm TTS may be too high a dose of oestradiol to administer on a long term basis.…”

mentioning

confidence: 99%

“…In addition, although the pharmacokinetics of 25, 50 and 100 μg doses of Estraderm TTS have been described in postmenopausal women (Powers et al 1985), there are few data concerning the actions of transdermal oestradiol patches on ovarian activity and serum oestradiol in premenopausal women. Watson et al (1988) determined that whilst administration of 200 μg of Estraderm TTS suppressed ovulation there was still evidence of ovarian follicular development, which suggests that spontaneous ovarian activity could make a contribution to the total serum oestradiol level in premenopausal women treated with oestrogen patches, and that the oestradiol levels achieved may be greater than those found in postmenopausal women treated with the same dose of oestradiol. The subsidiary aims of this study were therefore to determine the oestradiol levels produced by both 100 and 200 μg twice weekly doses of Estraderm TTS, and also to determine whether the lower dose would also suppress ovulation.…”

mentioning

confidence: 99%

A randomised comparison over 8 months of 100 μg and 200 μg twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome

Smith

Studd

Zamblera

et al. 1995

BJOG

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Objective To determine the efficacy of a 100 μg twice weekly dose of Estraderm TTS compared with a 200 μg 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. Design Main: randomised, prospective, comparative study. Subsidiary: cross‐sectional and prospective. Setting Premenstrual syndrome clinic in teaching hospital. Subjects Women with severe PMS confirmed by prospective daily symptom recording. Interventions Estraderm TTS® at a dose of either 100 or 200 μg twice weekly continuously with either dydrogesterone 10 mg or medroxyprogesterone acetate 5 mg, from day 17 to day 26 of each cycle. Main outcome measures 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 μg and 200 μg 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 Fg and 573 (494 to 693) with Estraderm 200 pg; 2. Estraderm 100 μg suppresses mid‐luteal progesterone from a mean (95% CI) of 353 (28.4 to 427) to 3.4 (2.4 to 4.5). Conclusions Estraderm TTS 100 μg twice weekly is as effective as 200 μg twice weekly in reducing symptom levels in severe premenstrual syndrome but is better tolerated. Estraderm 100 μg suppresses ovulation and results in a mean plasma oestradiol level similar to that observed in a spontaneous cycle.

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Suppression of ovulation by transdermal oestradiol patches.

Cited by 21 publications

References 6 publications

Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition

Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition

The premenstrual syndrome – a reappraisal of the concept and the evidence

A randomised comparison over 8 months of 100 μg and 200 μg twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome

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