Other treatments Hormonal treatment Hormonal treatments for PMS/P

Other treatments Hormonal treatment Hormonal treatments for PMS/PMDD are not supported by consistent scientific information in spite of evidence of hormonal involvement in the disorder.67 GnRH agonists, such as depot leuprolide68,69 and intranasal buserelin,70,71 effectively reduce PMS symptoms, but arc of limited use because of the risks associated with low estrogen levels, particularly osteoporosis, and these medications Inhibitors,research,lifescience,medical are viewed as appropriate only as a diagnostic tool or for patients who do not respond to other treatments. Results of preliminary

investigations of add-back therapy using low-dose estrogen and progesterone in conjunction with a GnRH agonist are inconsistent and do not yet definitively indicate that this is a safe as well as effective approach for long-term treatment.72-74 Limited data

indicate that tibolone (a selective estrogen enzyme modulator) administered with a GnRH agonist in PMS treatment protects against the bone loss observed with GnRH agonists and docs not reduce the therapeutic effect of the agonist.75 Inhibitors,research,lifescience,medical There are few randomized, placebo-controlled studies of oral contraceptives (OCs) as a treatment for severe PMS or PMDD, and no consistent scientific evidence Inhibitors,research,lifescience,medical of their efficacy for the disorder.76,77 A triphasic OC was more effective than placebo only for physical symptoms of breast pain and bloating.76 A recent Inhibitors,research,lifescience,medical trial of an OC containing a new progestin, an analog of spironolactone with antimineralocorticoid and antiandrogenic activity, showed a consistent reduction of both physical and behavioral PMS symptoms including dysphoric mood, but additional studies with sufficient statistical power are needed.78 From a clinical perspective, OCs are widely viewed as both improving and worsening PMS symptoms. Combination OCs have both estrogenic and progestational effects that vary considerably among the more than 40 compounds available in the USA. Relative absorption

of the hormones, peripheral conversion, the degree of follicular development Inhibitors,research,lifescience,medical in the placebo interval, individual susceptibility to monophasic or triphasic formulations, and side effects have large variations among women and are not well understood in relation to PMS. Moreover, OCs can have side effects of water retention, bloating, appetite changes, and depressed mood, which are also PMS symptoms. Some studies the showed that OC users had fewer PMS symptoms than nonusers overall,79 but other investigations found few symptom differences between the two selleck chemicals llc groups and no difference with respect to mood changes.80 In sum, there is little empirical support or guidance for OCs as a treatment for PMS/PMDD,81 although it is reasonable to try OCs, particularly when contraception is also required. If mood symptoms are predominant and persist, a serotonergic antidepressant is considered the first-line therapy.

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