leuprolide and Premenstrual-Syndrome

To investigate the neural substrate of premenstrual dysphoric disorder (PMDD), the authors used [15O]H2O positron emission tomography (PET) regional cerebral blood flow (rCBF) and blood-oxygen-level-dependent (BOLD) functional MRI (fMRI) signal measurements during working memory in conjunction with a 6-month hormone manipulation protocol.. PET and fMRI scans were obtained from women with prospectively confirmed PMDD and asymptomatic comparison subjects while they completed the n-back task during three hormone conditions: ovarian suppression induced by the gonadotropin-releasing hormone agonist leuprolide acetate, leuprolide plus estradiol, and leuprolide plus progesterone. Fifteen patients and 15 matched comparison subjects underwent PET imaging. Fourteen patients and 14 comparison subjects underwent fMRI. For each hormone condition, rCBF was measured with [15O]H2O PET, and BOLD signal was measured with fMRI, both during an n-back working memory paradigm. Global Assessment of Functioning Scale (GAF) scores and clinical characteristics were obtained for each patient before hormone manipulation, and symptoms were measured before and during the protocol.. In both the PET and fMRI studies, a main effect of diagnosis was observed, with PMDD patients showing greater prefrontal activation than comparison subjects. In the patient group, the degree to which dorsolateral prefrontal cortex activation was abnormally increased correlated with several dimensions of disease: disability as indicated by GAF scores, age at symptom onset, duration of PMDD, and differences in pre- and postmenses PMDD symptoms.. Abnormal working memory activation in PMDD, specifically in the dorsolateral prefrontal cortex, is related to PMDD severity, symptoms, age at onset, and disease burden. These results support the clinical relevance of the findings and the proposal that dorsolateral prefrontal cortex dysfunction represents a substrate of risk for PMDD. The concordance of the fMRI and PET data attests to the neurobiological validity of the results.

Topics: Adult; Brain Mapping; Drug Therapy, Combination; Estradiol; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Leuprolide; Magnetic Resonance Imaging; Memory, Short-Term; Oxygen; Positron-Emission Tomography; Prefrontal Cortex; Premenstrual Syndrome; Progesterone; Prospective Studies

Topics: Diagnosis, Differential; Drugs, Chinese Herbal; Estrogens; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Menstrual Cycle; Phytotherapy; Premenstrual Syndrome; Progesterone; Selective Serotonin Reuptake Inhibitors; Serotonin; Vitamin B 6

The author's aim is to aid primary care physicians and obstetrician-gynecologists in correctly diagnosing and treating premenstrual dysphoric disorder (PMDD). The symptoms fluctuate markedly, but their timing is key. PMDD patients experience symptoms only during the luteal phase and will have a symptom-free interval after the menstrual flow and before ovulation. The author discusses self-report instruments, which are valuable tools for diagnosis when combined with the ICD-10 criteria for premenstrual syndrome (PMS) or the DSM-IV criteria for PMDD and the ruling out of medical and psychiatric conditions, such as diabetes, hypothyroidism, major depression, and dysthymia, that cause similar symptoms. Treatment strategies ranging from nonpharmacologic approaches such as dietary modification and aerobic exercise to pharmacologic interventions such as antidepressants, anxiolytics, and agents to suppress ovulation are examined.

Topics: Anti-Anxiety Agents; Antidepressive Agents; Buserelin; Danazol; Depressive Disorder; Diagnosis, Differential; Estrogen Antagonists; Female; Gynecology; Humans; Leuprolide; Medical Records; Obstetrics; Ovulation; Practice Patterns, Physicians'; Premenstrual Syndrome; Primary Health Care; Professional Practice; Psychiatric Status Rating Scales; Severity of Illness Index

During conditions of ovarian suppression, women with premenstrual dysphoria (PMD) experience abnormal behavioral responses to physiological levels of ovarian steroids. Although hypothalamic-pituitary-adrenal (HPA) axis dysregulation frequently accompanies depression, and ovarian steroids regulate HPA axis responsivity, the role of HPA axis dysregulation in PMD is not known. We hypothesized that women with PMD would show abnormalities of HPA axis function analogous to those reported in depressive illness, and that ovarian steroids would differentially regulate HPA axis function in women with PMD compared with asymptomatic controls (AC).. Our objective was to characterize the HPA axis response to physiological levels of estradiol and progesterone in women with PMD and AC.. We conducted an open-label trial of the GnRH agonist depot Lupron with ovarian steroid replacement administered in a double-blind crossover design in an outpatient clinic.. Forty-three women (18 with prospectively confirmed PMD and 25 AC) participated.. Women received Lupron for 6 months. After 3 months of hypogonadism, women received 5 wk each of estradiol (100-μg patch daily) or progesterone (suppositories 200 mg twice daily). During each condition, combined dexamethasone-suppression/CRH-stimulation tests and 24-h urinary free cortisol levels were performed.. Plasma cortisol and ACTH levels were evaluated.. HPA axis function was similar in PMD compared with AC. In all, progesterone significantly increased the secretion of cortisol compared with estradiol [area under the curve (t(74) = 3.1; P < 0.01)] and urinary free cortisol (t(74) = 3.2; P < 0.01) and ACTH compared with hypogonadism [area under the curve (t(74) = 2.4; P < 0.05)].. HPA axis regulation is normal in PMD, suggesting that the pathophysiology of PMD differs from major depression. As observed previously, progesterone but not estradiol up-regulates HPA axis function in women.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Corticotropin-Releasing Hormone; Cross-Over Studies; Dexamethasone; Drug Therapy, Combination; Estradiol; Female; Fertility Agents, Female; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Hypogonadism; Hypothalamo-Hypophyseal System; Leuprolide; Middle Aged; Pituitary-Adrenal System; Premenstrual Syndrome; Progesterone; Young Adult

Approximately 60-70 percent of women with premenstrual dysphoric disorder (PMDD) show symptomatic improvement in response to the GnRH agonist leuprolide acetate, which suppresses ovarian function. However, it has been very difficult to either predict or understand why some women respond, while others do not. We applied several complementary statistical methods to the dynamics of pre-treatment mood rating data to determine possible predictors of response for women with PMDD. We compared responders (n = 33) to nonresponders (n = 12) in clinical trials of leuprolide (three months in duration) as a treatment for PMDD, on the basis of pre-trial daily self-ratings of sadness, anxiety, and irritability. We analyzed both sequential irregularity (approximate entropy, ApEn) and a quantification of spikiness of these series, as well as a composite measure that equally weighted these two statistics. Both ApEn and Spikiness were significantly smaller for responders than nonresponders (P ≤ 0.005); the composite measure was smaller for responders compared with nonresponders (P ≤ 0.002) and discriminated between the subgroups with high sensitivity and specificity. In contrast, mean symptom levels were indistinct between the subgroups. Relatively regular and non-spiky pre-trial dynamics of mood ratings predict a positive response to leuprolide by women with PMDD with high probability, moreover based on typically less than 3 months of daily records. The statistical measures may have broad and direct applicability to behavioral studies for many psychiatric disorders, facilitating both accurate diagnosis and the prediction of response to treatment.

Topics: Adult; Entropy; Female; Fertility Agents, Female; Hormones; Hot Flashes; Humans; Leuprolide; Mood Disorders; Nonlinear Dynamics; Predictive Value of Tests; Premenstrual Syndrome; Psychiatric Status Rating Scales; Statistics, Nonparametric; Young Adult

The aim of this study was to investigate which add-back hormone replacement therapy would be most beneficial in terms of mood effects for patients with premenstrual dysphoric disorder who are receiving gonadotropin-releasing hormone agonist therapy.. Three different add-back hormone replacement treatments were evaluated in a randomized, double-blinded, cross-over clinical trial in 27 patients premenstrual dysphoric disorder. The add-back treatments consisted of 1.5 mg estradiol and 400 mg progesterone, 1.5 mg estradiol and placebo, and 0.5 mg estradiol and 400 mg progesterone. The primary outcome measure was daily symptom ratings for mood and physical symptoms.. The highest dose of estradiol in combination with progesterone was associated with the most pronounced symptom recurrence, both in comparison with a lower dose of estradiol together with progesterone and estradiol-only treatment.. Based on the findings of the present study, long-cycle add-back treatment to avoid frequent progestagen use appears to be most beneficial for patients with premenstrual dysphoric disorder.

Topics: Adult; Affect; Anxiety; Cross-Over Studies; Depression; Double-Blind Method; Drug Therapy, Combination; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Irritable Mood; Leuprolide; Middle Aged; Mood Disorders; Placebos; Premenstrual Syndrome; Progesterone; Treatment Outcome

Leptin seems to regulate reproductive function and it has been hypothesised that its secretion may be induced by oestrogens. Changes in its levels has been advocated as a determinant in the pathogenesis of premenstrual syndrome (PMS). We evaluated serum leptin levels in patients affected by PMS and in controls to establish: (i) if induced hypoestrogenism has an impact on leptin concentrations; (ii) if the administration of tibolone modifies the effects of hypoestrogenism on serum leptin levels; and (iii) if the improvement in PMS symptomatology can be correlated to changes in serum leptin levels.. Prospective, randomized study.. Twenty-eight women affected by PMS and 20 unaffected controls. Affected patients were randomly assigned to two groups to receive leuprolide acetate (3.75 mg intramuscularly) plus tibolone (2.5 mg/day) (group A; n = 14) or plus placebo (group B; n = 14), at the onset of the vasomotor symptoms.. Serum leptin, oestradiol and progesterone levels, PMS signs and symptoms evaluated during a 2 months' pretreament period and after 2 months of therapy.. No differences in leptin levels among the three groups and within the same group at all time evaluated were observed. Oestradiol and progesterone concentrations were significantly lower in all groups during treatment in comparison with pretreatment values. Before therapy, leptin levels were positively correlated both with oestradiol and progesterone in the follicular and luteal phase in all groups. This correlation was lost after treatment. All PMS patients showed a significant improvement of the symptomatology.. Hypoestrogenism induced by GnRH analogues (GnRHa) does not seem to influence leptin levels in normal women and those with PMS, and the addition of tibolone does not impact on these levels. Because PMS symptomatology did significantly improve during treatment with GnRHa alone, or in associtation with tibolone, it is unlikely that changes in leptin levels could have an important role in the pathophysiology of PMS.

Topics: Adult; Androgen Antagonists; Case-Control Studies; Estradiol; Female; Fertility Agents; Humans; Leptin; Leuprolide; Menstrual Cycle; Norpregnenes; Premenstrual Syndrome; Progesterone; Prospective Studies; Treatment Outcome

To evaluate the effectiveness of GnRH agonist (GnRH-a) plus tibolone in the treatment of severe premenstrual syndrome (PMS).. Prospective, double-blind, placebo-controlled clinical trial.. Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy. PATIENT(S); Thirty patients affected by severe PMS, aged 23-29 years (mean age +/- SD, 25.3 +/- 2.9 years).. Treatment for two cycles with leuprolide acetate depot (3.75 mg IM for 28 days) in association with tibolone (2.5 mg/d orally) or placebo (1 tablet per day orally).. The mean severity of each symptom and sign of PMS was evaluated using a visual analog scale during the last 7 days of each treatment cycle in comparison with the last 7 days of the cycle before treatment.. Mean scores for each of the adverse psychological/physical and positive psychological symptoms were significantly improved during treatment. No statistically significant difference was detected between patients treated with tibolone and placebo. A significantly lower number of hot flushes per day was observed in groups treated with GnRH-a and tibolone in comparison with GnRH-a and placebo.. Tibolone administered in association with GnRH-a does not reduce the therapeutic effect of GnRH-a in women affected by PMS. Tibolone used in association with GnRH-a may provide long-term medical treatment for women with PMS.

Topics: Adult; Anabolic Agents; Double-Blind Method; Drug Therapy, Combination; Female; Hot Flashes; Humans; Leuprolide; Norpregnenes; Placebos; Premenstrual Syndrome; Prospective Studies

GABA receptor-modifying neurosteroids may play a role in premenstrual syndrome (PMS). The peripheral benzodiazepine receptor (PBR) both regulates the formation of neurosteroids and is, in animals, regulated by ovarian steroids. Alterations in PBR density have been observed in association with several psychiatric disorders.. We examined the effects of gonadal steroids on lymphocytic PBR density in nine women with prospectively confirmed PMS and nine controls. PBR densities were measured during three pharmacologically controlled conditions: gonadotropin releasing hormone agonist (Lupron)-induced hypogonadism, Lupron plus estradiol, and Lupron plus progesterone replacement. Blood samples were obtained after six weeks of Lupron alone and after 3-4 weeks of estradiol and progesterone replacement.. No significant hormone state-related changes in PBR density were observed (ANOVA-R: phase-F(2,32)=1.5, P=0.2). Despite mood symptom development in the subjects with PMS, PBR density did not differ in women with PMS compared to controls across hormonal states (ANOVA-R: F(1,16)=0.6, P=0.4).. PBR densities are not altered in women with PMS and are not changed significantly by selective gonadal steroid administration. Changes in PBR density would not appear to underlie the differential sensitivity to the mood destabilizing effects of ovarian steroids in PMS.

Topics: Affect; Estradiol; Female; Humans; Leuprolide; Lymphocytes; Premenstrual Syndrome; Progesterone; Receptors, GABA-A

The symptoms of women with premenstrual syndrome improve in response to suppression of ovarian function, although these women have no evidence of ovarian dysfunction. We undertook a study to determine the role of estrogen and progesterone in this syndrome.. We first studied the effect of ovarian suppression with leuprolide, an agonist analogue of gonadotropin-releasing hormone, or placebo on symptoms in 20 women with the premenstrual syndrome. Ten women whose symptoms improved during leuprolide treatment were given estradiol and progesterone in a double-blind, crossover design, each for four weeks, during continued leuprolide administration. Women without premenstrual syndrome (normal women) participated in a similar protocol. Outcomes were assessed on the basis of daily self-reports by the patients and biweekly rater-administered symptom-rating scales.. The 10 women with premenstrual syndrome who were given leuprolide had a significant decrease in symptoms as compared with base-line values and with values for the 10 women who were given placebo. The 10 women with premenstrual syndrome who were given leuprolide plus estradiol or progesterone had a significant recurrence of symptoms, but no changes in mood occurred in 15 normal women who received the same regimen or in 5 women with premenstrual syndrome who were given placebo hormone during continued leuprolide administration.. In women with premenstrual syndrome, the occurrence of symptoms represents an abnormal response to normal hormonal changes.

Topics: Adult; Cross-Over Studies; Double-Blind Method; Emotions; Estradiol; Female; Gonadotropin-Releasing Hormone; Hot Flashes; Humans; Leuprolide; Middle Aged; Premenstrual Syndrome; Progesterone

Gonadotropin-releasing hormone (GnRH) agonists have been shown to reduce symptoms of premenstrual syndrome (PMS). This randomized, placebo-controlled study examined the efficacy of the GnRH agonist, leuprolide acetate depot, in a clearly defined PMS sample versus women with premenstrual symptoms in combination with dysphoric symptoms throughout the cycle, termed the premenstrual exacerbation (PME) group. Evaluation included the Structured Clinical Interview for DSM-III-R, administered in the follicular phase, and the subject Penn Dally Symptoms Report (DSR) maintained throughout the study. Thirty-three eligible women were randomized to double-blind treatment and administered 3.75 mg of depot leuprolide or a placebo once a month for 3 months. The subjects were seen for efficacy evaluations at the end of each cycle. Outcome measures were the DSRs and the 17-item Hamilton Depression Rating Scale (HAM-D17). The PMS leuprolide subjects improved significantly compared with the PMS placebo and PME leuprolide groups. The PME leuprolide group, who had dysphoric symptoms throughout the cycle, did not improve. Depression symptoms were at clinical levels premenstrually in the PMS and PME groups; following treatment they remitted in the PMS group but not in the PME leuprolide subjects. Efficacy did not occur until after several months of leuprolide treatment, but there was no evidence that PMS symptoms worsened with the onset of treatment. These results replicate the findings in our preliminary open-label study. Leuprolide reduced PMS symptoms to minimal levels where symptoms were limited to the luteal phase. Leuprolide was not effective for women with ongoing dysphoric symptoms, suggesting that premenstrual depression may have mechanisms different from those of other dysphoric mood disorders.

Topics: Adult; Depression; Double-Blind Method; Female; Humans; Leuprolide; Premenstrual Syndrome; Psychiatric Status Rating Scales; Single-Blind Method

To test the effectiveness and safety of long-term depot leuprolide acetate (GnRH-a) plus estrogen and progestin add-back therapy in the treatment of moderate and severe premenstrual syndrome (PMS).. A prospective trial with each patient serving as her own control.. University teaching hospital.. Ten women with regular menstrual cycles complaining of moderate to severe PMS. Premenstrual syndrome was diagnosed when symptoms increased > or = 25% during the luteal phase.. Four-week cycles of IM injections of placebo or GnRH-a with all patients receiving saline (placebo), the first cycle followed by 12 cycles of GnRH-a, 7.5 mg. Conjugated equine estrogen (0.625 mg/d) was started Monday through Saturday within the first cycle and increased as needed. Medroxyprogesterone acetate (MPA), 10 mg/d, was taken orally for 10 days after 4, 8, and 12 cycles of GnRH-a therapy.. Changes in three symptom categories (water retention, pain, and psychological function), serum levels of total cholesterol and HDL, HDL-2, and LDL cholesterol, E2, and estrone. Endometrial biopsy was obtained 1 day after the end of the 12th GnRH-a cycle, and bone density was assessed using quantitative computer tomography at the end of the 12th GnRH-a cycle.. During treatment, there was a significant decrease compared with baseline and placebo in all three symptom categories. There were no significant changes in lipids. Endometrial biopsies revealed progestational changes with no evidence of hyperplasia. Quantitative computer tomography bone density dropped 3.7 on average compared with baseline after 12 months of treatment, but this was not statistically significant.. Gonadotropin-releasing hormone agonist therapy with hormonal add-back therapy is effective in treating PMS symptoms with progressive improvement over a 12-month period. This therapy prevents changes in lipids and adequately protects the endometrium with the addition of MPA every 4th cycle. Quantitative computer tomography bone density dropped at 12 months; further examination of bone changes is necessary.

Topics: Adult; Bone Density; Delayed-Action Preparations; Endometrium; Estradiol; Estrogens; Estrone; Female; Humans; Leuprolide; Medroxyprogesterone Acetate; Premenstrual Syndrome; Prospective Studies

To determine whether depot leuprolide is effective in premenstrual syndrome (PMS) and whether symptom type or severity affects therapeutic or hormonal responses and the incidence of adverse events.. Twenty-five women who met strict diagnostic criteria for PMS completed a double-blind, placebo-controlled, 6-month crossover trial at a university medical center. Depot leuprolide (3.75 mg/month) or saline was administered intramuscularly for three consecutive treatment cycles. Efficacy, adverse events, and hormone concentrations were assessed at each visit. Repeated-measures analysis of variance was used to analyze continuous data, and ordinal and binary data were analyzed using nonparametric techniques.. Depot leuprolide treatment was significantly more effective than placebo on all rating scales. Irritability, neurologic symptoms, breast tenderness, and fatigue were most responsive to treatment. Symptoms were reduced to follicular phase levels only in women without premenstrual depression. Those with moderate premenstrual depression improved but remained clinically symptomatic, whereas the group with severe premenstrual depression showed no improvement on any efficacy measure. Adverse events were lowest in those without premenstrual depression and highest in those with severe depression. Leuprolide suppressed estradiol and progesterone in most premenstrual depression groups but had varying effects on gonadotropins.. Leuprolide treatment reduced both behavioral and physical symptoms and was well tolerated in the absence of severe premenstrual depression. Women should be evaluated for depression severity before receiving a GnRH agonist. The differential response to leuprolide suggests that it may possess diagnostic value in determining distinct subtypes of PMS.

Topics: Adolescent; Adult; Cross-Over Studies; Delayed-Action Preparations; Depression; Double-Blind Method; Estradiol; Female; Follicle Stimulating Hormone; Humans; Injections, Intramuscular; Leuprolide; Luteinizing Hormone; Middle Aged; Premenstrual Syndrome; Progesterone

The results of long-acting, injectible gonadotropin releasing hormone agonist (GnRH-a) and placebo treatment of severe premenstrual syndrome (PMS) patients with regular menstrual cycles and without known psychiatric disorders are reported. Diagnosis was made according to the Menstrual Symptom Questionnaire and Menstrual Symptom Diary scores. In a placebo-controlled, crossover study, 12 subjects were given either normal saline or depot leuprolide acetate (7.5 mg) every 30 days, starting with the onset of menses. Each subject received the same agent twice before switching to the other and did not known which agent was given. A significant decrease in PMS symptoms was reported by all subjects in both treatment regimens. Biweekly venous blood sampling showed significant elevations of beta-endorphin levels and suppression of gonadotropin concentrations in subjects receiving depot leuprolide treatment. Short-term treatment of severe PMS with an injectible, long-acting GnRH-a may not treat the disease more than do saline injections in a group of women selected by certain criteria.

Topics: Adult; beta-Endorphin; Delayed-Action Preparations; Female; Gonadotropins, Pituitary; Humans; Injections, Intramuscular; Leuprolide; Middle Aged; Premenstrual Syndrome; Treatment Outcome

Topics: Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Placebo Effect; Premenstrual Syndrome; Triptorelin Pamoate

Gonadotropin-releasing hormone agonist (GnRHa) in depot form for once-a-month rather than daily injection was examined in a small open trial to determine the extent of reduction of premenstrual symptoms, particularly premenstrual "depression.". Women who met criteria for premenstrual syndrome (PMS) or for PMS with comorbidity of major depression (MD), based on DSM-III-R criteria, were evaluated for the study. Evaluation included Structured Clinical Interview for DSM-III-R, administered in the follicular phase, and Daily Symptom Report (DSR), maintained throughout the study. Seven PMS subjects and two subjects who met the severity and change criteria for PMS but had concurrent MD were administered 3.75 mg of depot leuprolide monthly. Symptom change as reported on the DSR was compared with the untreated baseline scores.. Six of seven PMS subjects had cessation of menses and significant decreases in premenstrual symptoms (p < .0001), which were reduced to their follicular phase levels. Physical symptoms of swelling and breast tenderness were among the most improved symptoms. Despite cessation of menses, the two MD subjects showed little improvement in premenstrual symptoms and no improvement in depressive symptoms. The premenstrual depression scores decreased almost completely in the PMS subjects, but increased slightly in the MD subjects.. This small open trial suggests that GnRH agonist therapy reduces premenstrual symptoms including "depression" in women who meet criteria for PMS but not in women with PMS and MD. Further controlled study of the role of ovarian function in mood disorders is needed.

Topics: Adult; Comorbidity; Delayed-Action Preparations; Depressive Disorder; Female; Humans; Leuprolide; Pilot Projects; Premenstrual Syndrome; Psychiatric Status Rating Scales

Topics: Allergens; Dermatitis; Estrogens; Female; Follow-Up Studies; Humans; Leuprolide; Middle Aged; Patch Tests; Periodicity; Premenstrual Syndrome; Rare Diseases; Risk Assessment; Severity of Illness Index; Treatment Outcome

Previous studies in animals indicate that reproductive steroids are potent modulators of the hypothalamic-pituitary-adrenal (HPA) axis, a physiologic system that is typically dysregulated in affective disorders, such as major depression. Determination of the role of reproductive steroids in HPA axis regulation in humans is of importance when attempting to understand the pathophysiology of premenstrual syndrome (PMS), a disorder characterized by affective symptoms during the luteal phase of the menstrual cycle. We performed two studies using treadmill exercise stress testing to determine the effect of menstrual cycle phase and diagnosis on the HPA axis in women with PMS and controls and the role of gonadal steroids in HPA axis modulation in control women. The results of these studies indicate that women with PMS fail to show the normal increased HPA axis response to exercise during the luteal phase and that progesterone, not estradiol, produces increased HPA axis response to treadmill stress testing in control women. These data demonstrate that women with PMS, when symptomatic, appear to have an abnormal response to progesterone and, furthermore, do not display the HPA axis abnormalities characteristic of major depression.

Topics: Adrenocorticotropic Hormone; Adult; Arginine Vasopressin; Exercise; Female; Fertility Agents, Female; Follicular Phase; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Leuprolide; Luteal Phase; Pituitary-Adrenal System; Premenstrual Syndrome

Topics: Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Norpregnenes; Premenstrual Syndrome

Topics: Emotions; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Premenstrual Syndrome; Progesterone

Despite the interest in premenstrual syndrome (PMS) taken by the media and the public in recent years, some women still do not recognize the cyclic nature of their symptoms. Thus, PMS continues to elude diagnosis. Dr Nader discusses the major categories of symptoms and when they occur, summarizes theories on the cause of PMS, and comments on how well these theories have been substantiated by testing. Choosing agents for treatment on the basis of symptoms to be controlled is also described.

Topics: Bromocriptine; Contraceptives, Oral; Danazol; Diuretics; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Mefenamic Acid; Premenstrual Syndrome; Progesterone; Pyridoxine