Hormonal therapy in the management of premenstrual syndrome

Premenstrual syndrome (PMS) is characterized by any of a number of physical and psychological symptoms consistently occurring in the late luteal phase. Progesterone therapy is often recommended based on anecdotal evidence, although controlled studies have shown it to be ineffective. Oral contraceptives are more often used with mixed results. When hormonal therapy for PMS is indicated, the most appropriate choice remains a challenge.

We describe a case report of successful hormonal therapy for PMS and a review of the literature on the effectiveness of hormonal therapies.

Estrogen is clearly effective in relieving symptoms of PMS, whereas progesterone is ineffective and might even worsen symptoms. Combination oral contraceptives are effective, undoubtedly as a result of the estrogen component. While little comparative data exist to guide choice of an oral contraceptive, maximizing the relative estrogenic potency of the oral contraceptive seems logical. Depressive symptoms might not respond to hormonal treatment, and new research suggests that selective serotonin reuptake inhibitors might be particularly effective.