One of the pioneers of PMS diagnosis and treatment has been a strong advocate of progesterone pessaries (Cyclogest - Shire). Research has failed to confirm any evidence of imbalance in progesterone levels between those with and those without PMS. From a theoretical point of view, PMS occurs at the time that the body is producing progesterone so that progesterone deficiency is unlikely to be the problem. Although scientifically controlled studies have never proven its benefit, the fact remains that many women continue to take this form of treatment and they are convinced of its efficacy. Postmenopausal women given oestrogen replacement therapy and cyclical progestogens (Q 28.09) sometimes report recurrence of PMS type symptoms; dydrogesterone (Duphaston - Solvay), medroxyprogesterone acetate (Provera Pharmacia and Upjohn) and progesterone itself seems to have this side-effect less frequently than other progestogens. Duphaston and norethisterone are licensed for use in PMS but scientific control studies tend to show no improvement over placebo (placebo & controlled trials). Progesterone as a vaginal gel (Crinone) introduced on alternate nights became available in 1997 and some find Progest (progesterone replacment therapy) helpful. Depo-Provera used in family planning (Depo-Provera) is administered on a three monthly basis.
A 42 year old lady presented with a history of depression and a suggestion that her problem could be PMS. She had the typical appearance of a severely depressed person. At times she had required hospital admission under the care of a psychiatrist. There was certainly an element of a cyclical increase in her symptoms and at that time it seemed reasonable to offer hormonal treatment on a trial basis. She received dydrogesterone during the second half of the cycle. When she returned a few weeks later she was vivacious and enjoying life to the full. All was well for about a year when she returned quite depressed despite having continued with the dydrogesterone. It turned out that she had recently received an antibiotic for a respiratory infection and this could have altered the absorption of the drug. With increased progestogen the problem resolved and in her case her severe symptoms were effectively controlled by dydrogesterone alone until she reached her menopause. It should be emphasised that this case is unusual. Every person, however, is an individual and although such improvement would not be predictable on the evidence of large studies, in my view the practice of medicine is still an art based on science. Only politicians could believe that medicine is a pure science.
Related Medical Abstracts - Click on the paper title:-
- Progesterone for Premenstrual Syndrome. (2006-01)
- Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review. (2001)
- The aetiology of
premenstrual syndrome is with the progesterone receptors. (1990)
Please click on the required question.
- Premenstrual Syndrome - PMS What is The Premenstrual Syndrome (PMS)
- 2 How prevalent is PMS?
- 3 How can we tell if I have PMS?
- 4 How can my PMS be evaluated?
- 5 How can cyclical breast pain (mastalgia) be treated?
- 6 How can my PMS be treated?
- 7 What is the place of progestogens and progesterone in the management of PMS?
- 8 Could suppressing my menstrual cycle reduce my PMS problems?
- 9 Could a diuretic help my PMS?
- 10 Is there a place for anti-depressants or anxiolytic drugs in the management of PMS?
- 11 Is there a place for removing my ovaries in the management of PMS?
- 12 What can be done about my decreased libido (sex drive)
- 12A What is the place of Viagra (sildenafil citrate) in sexual dysfunction in women?
- 13 How is PMS treatment monitored?
- 14 How long should PMS treatment be taken?
- 15 What is the chronic fatigue syndrome?
- 16 What is seasonal affective disorder (SAD)
- 17 Where can I obtain more information?
- 18 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
