PMS

August 2007: Focus on PMDD and Hormonal Methods

Posted 08/24/2007

Lee P. Shulman, MD 
Author Information

Your browser may not support display of this image.Introduction

For women with severe premenstrual dysphoric disorder (PMDD) whose symptoms persist despite receiving US Food and Drug Administration (FDA)-approved pharmacologic therapy and instituting recommended lifestyle changes (eg, dietary and exercise regimens and relaxation techniques), other measures are sometimes used in clinical practice. These include ovarian suppression via treatment with a gonadotropin-releasing hormone agonist, combination or progestin-only oral contraceptives, cutaneous and subcutaneous delivery of estrogen/progestin, surgical removal of ovaries via ovariotomy, and the more radical procedure involving surgical removal of the ovaries and fallopian tubes, (ie, bilateral salpingo-oophorectomy with adequate hormone replacement).

Currently, only 1 hormonal method has FDA approval for the treatment of PMDD symptoms. An oral contraceptive (OC) formulation containing drospirenone 3 mg/ethinyl estradiol 20 mcg was approved by the FDA in 2006 for use in women desiring hormonal contraception.[1,2] The following summaries highlight journal articles and study findings reported within the past year pertaining to the hormonal mechanisms of PMDD and ovarian suppression based treatment approaches for managing symptoms of premenstrual disorders, excluding the approved OC.

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  1. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005;106:492-501. Abstract
  2. Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005;72:414-421. Abstract
  3. Watts JF, Butt WR, Logan Edwards R. A clinical trial using danazol for the treatment of premenstrual tension. Br J Obstet Gynaecol. 1987;94:30-34. Abstract
  4. Hammarback S, Backstrom T. Induced anovulation as treatment of premenstrual tension syndrome. A double-blind cross-over study with GnRH-agonist versus placebo. Acta Obstet Gynecol Scand. 1988;67:159-166. Abstract
  5. Leather AT, Studd JWW, Watson NR, Holland EFN. The treatment of severe premenstrual syndrome with goserelin with and without ‘add-back’ estrogen therapy: a placebo-controlled study. Gynecol Endocrinol. 1999;13:48-55. Abstract
  6. Casson P, Hahn PM, Van Hugt DA, Reid RL. Lasting response to ovariectomy in severe intractable premenstrual syndrome. Am J Obstet Gynecol. 1990;162:99-105.Abstract
  7. Casper RF, Hearn MT. The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome. Am J Obstet Gynecol. 1990;162:105-109. Abstract
  8. Magos AL, Brewster E, Singh R, O’Dowd T, Brincat M, Studd JW. The effects of norethisterone in postmenopausal women on oestregen replacement therapy: a model for premenstrual syndrome. Br J Obstet Gynaecol. 1986;93:1290-1296. Abstract

Medscape Ob/Gyn & Women’s Health.  2007; ©2007 Medscape

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