This Article Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MORTOLA, J. F. Articles by FISCHER, U. Search for Related Content PubMed Articles by MORTOLA, J. F. Articles by FISCHER, U.

Successful Treatment of Severe Premenstrual Syndrome by Combined Use of Gonadotropin-Releasing Hormone Agonist and Estrogen/Progestin^*

J. F. MORTOLA, L. GIRTON and U. FISCHER

Department of Reproductive Medicine, University of California-San Diego School of Medicine (T-002) La Jolla, California 92093

Although abolishment of ovarian cyclicity by the use of a long-acting GnRH agonist (GnRH-a) provides effective treatment for premenstrual syndrome (PMS), its use is limited by sequellae of the resultant hypoestrogenism. In this study the effects of estrogen/progestin replacement on the symptomatic improvement afforded by GnRH-a were evaluated in eight women with severe PMS. The 8-month study design included 2 months of control, 2 months of GnRH-a alone, and 4 further months in which the exogenous steroids were replaced in randomized, double blind, placebo-controlled cross-over fashion using 1 month each of 1) conjugated equine estrogen (CEE) on days 1–25, 2) 10 mg medroxyprogesterone acetate (MPA) on days 16–25, 3) CEE (days 1–25) plus MPA (days 16–25), and 4) placebo alone. Mood and physical symptoms were measured daily on a valid and reliable instrument, the Calendar of Premenstrual Experiences.

As expected, administration of GnRH-a alone resulted in a 75% improvement in luteal phass symptom scores (17.8 ± 4.8 vs. 4.2 ± 1.6; P < 0.01). Combined sequential administration of CEE and MPA in addition to GnRH-a was effective in maintaining the reduced symptom scores seen after GnRH-a alone and was superior to the addition of CEE alone, MPA alone, or placebo. This combination of CEE and MPA resulted in a 60% improvement (P < 0.05) compared to the luteal phase of control months in both behavioral (14.1 ± 3.9 vs. 4.2 ± 0.8) and total (17.8 ± 4.8 vs. 6.5 ± 1.8) symptoms. We conclude that the undesirable consequence of ovarian steroid deficiency in the treatment of PMS by GnRH-a can be overcome by the addition of sequential estrogen and progsstogen replacements without significantly reducing the effectiveness of GnRH-a in this disorder.

^* This work was supported by NIH NICHHD Center Grant HD-12303 and in part by the Mellon Foundation. This research was conducted in part by the Clayton Foundation for Research. This work was presented in part at the Society of Gynecologic Investigation, 1989.

Mellon Foundation Faculty Scholar. To whom all correspondence and requests for reprints should be addressed.

Received May 21, 1990.

This article has been cited by other articles:

				J. B. Becker, A. P. Arnold, K. J. Berkley, J. D. Blaustein, L. A. Eckel, E. Hampson, J. P. Herman, S. Marts, W. Sadee, M. Steiner, et al. Strategies and Methods for Research on Sex Differences in Brain and Behavior Endocrinology, April 1, 2005; 146(4): 1650 - 1673. [Abstract] [Full Text] [PDF]

				A. M. Case and R. L. Reid Effects of the Menstrual Cycle on Medical Disorders Arch Intern Med, July 13, 1998; 158(13): 1405 - 1412. [Abstract] [Full Text]