Am J Obstet Gynecol. 2006 Nov;195(5):1311-9.

Oral contraceptives and premenstrual symptoms: comparison of a 21/7 and extended regimen.


Coffee AL ,Kuehl TJ,Willis S,Sulak PJ.

Department of Obstetrics and Gynecology, Scott and White Memorial Hospital, Texas AandM University System Health Science Center College of Medicine, Temple, TX 76508, USA.


The purpose of this study was to assess the incidence and severity of premenstrual-type symptoms in patients converted from a 21/7 oral contraceptive (OC) regimen to an extended regimen.

Study Design:

This was a single center prospective analysis of the single item Scott and White (SandW) Mood Scale and the Penn State Daily Symptom Report (DSR17) during a 21/7-day followed by a 168-day extended regimen of an OC containing 3 mg of drosperinone and 30 microg of ethinyl estradiol (DRSP/EE).


Of the 114 patients who began the study, 111 completed the preextension 21/7 phase of the study. There were significant differences in severity in the DSR17 and the SandW mood scale among days of the cycle. (P< .0001) The highest values in both scales occurred during the 7-day hormone free interval (HFI) of the 21/7 cycles (P< .001). Of the 111 patients who completed the 21/7 phase of the study, 102 (92%) completed the 168-day extended regimen. During the extended phase of the study, subjects were divided into 2 groups: those with a 100% increase in symptoms from the first half to the second half of the last 21/7 cycle were labeled as high cyclic variability, whereas those with lesser or no cyclic change were labeled as low cyclic variability. There were 55 (54%) with increased cyclic variability in mood scores peaking during the 7-day HFI. Premenstrual-type symptoms measured by both the SandW mood scale and the DSR17 instrument decreased during the extended DRSP/EE OC regimen (P< .0001) compared with the preceding 21/7 cycle, with the greatest improvement detected in the sixth month of continuous OCs (P< .003). The patient group with greatest cyclic variability during the 21/7 regimen demonstrated the most improvement during the 168-day regimen (P< .0001). The single item SandW mood scale was significantly (P< .05) correlated to each of 17 elements of the DSR17 with Spearman R correlation coefficients of 0.25 to 0.57. The greatest correlation coefficient (Spearman's R = 0.66) is with the sum of all 17 items.


A 168-day extended regimen of DRSP/EE led to a decrease in premenstrual-type symptoms compared with the 21/7-day regimen.

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