Abstract

Objective: To study whether the addition of estrogen to the 7 hormone-free days of a combined oral contraceptive (OC) cycle improves the symptomatology in perimenopausal women with climacteric complaints. Design: A total of 56 women in their forties presenting with mood disorders and/or hot flashes were included in this randomized double-blind study. Symptoms were evaluated using the Greene test. Subjects were allocated into two groups: 23 women received an OC containing 20 ?g of ethinyl-estradiol and 150 mg of desogestrel for 21 days and then 7 placebo tablets (placebo group); the other 33 women received 21 tablets with the same hormone combination, followed by 2 placebo tablets and 5 ethinyl-estradiol tablets of 10 ?g each (estrogen group). After three cycles, symptoms were reassessed. Results: Symptoms were similar in the two groups at the start of the study. Three months later, vasomotor symptoms in the placebo group dropped from 3.3 ± 1.7 to 1.7 ± 1.8, and in the estrogen group, from 3.0 ± 1.7 to 0.7 ± 0.9 (p < 0.04). Similarly, symptoms of depression fell from 8.8 ± 4.0 to 6.7 ± 3.9 in the placebo group and from 10.3 ± 3.5 to 3.8 ± 2.9 in the estrogen group (p < 0.002). Somatic symptoms fell with placebo from 10.9 ± 5.3 to 7.4 ± 5.4, and with estrogen, from 9.7 ± 4.9 to 4.0 ± 2.5 (p < 0.03). Sexual dysfunction as measured by the Greene Scale (loss of sexual interest) also improved more in women who received additional estrogen: 2.0 ± 0.9 to 0.5 ± 0.9 vs. 1.8 ± 1.2 to 1.2 ± 1.2, p < 0.03. Anxiety symptoms improved in both groups but without any significant difference between them. Conclusions: Adding 5 days of estrogen to the classic contraceptive scheme improves the climacteric symptoms of perimenopausal women who use OCs.