title: The treatment of severe premenstrual syndrome with goserelin with and without 'add-back' estrogen therapy: a placebo-controlled study.
abstract: The study aimed to determine if the addition of daily low-dose oral estrogen with a cyclical progestogen given to young women using a depot gonadotropin-releasing hormone (GnRH) analog implant for the treatment of their premenstrual syndrome (PMS) would affect the clinical outcome. In a double-blind placebo-controlled study in a specialist premenstrual syndrome clinic setting, 60 women aged between 20 and 45 years were randomized to one of three treatment groups: Group A (placebo implant four weekly + placebo tablets daily), Group B (goserelin 3.6 mg implant four weekly + estradiol valerate 2 mg daily with norethisterone 5 mg from days 21-28 of a 28-day cycle) or Group C (goserelin 3.6 mg implant four weekly + placebo tablets daily). Differences between PMS scores at 2, 4 and 6 months were compared with pretreatment values. There was a significant improvement in PMS scores in Group C (Zoladex + placebo) after 2, 4 and 6 months of treatment when compared to pretreatment values and Group A (placebo + placebo). The addition of a low-dose oral estrogen with a cyclical progestogen to GnRH analog treatment (Group B) resulted in a less dramatic response when compared to pretreatment values and no significant improvement when compared to Group A (placebo + placebo) at 2, 4 and 6 months of treatment. The addition of a low-dose oral estrogen with a cyclical progestogen to depot GnRH analog therapy in the treatment of PMS reduces the clinical response.
authors.affiliation: Chelsea and Westminster Hospital PMS Clinic, Lister Hospital, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Leather
authors.forename: J W
authors.initials: JW
authors.lastname: Studd
authors.forename: N R
authors.initials: NR
authors.lastname: Watson
authors.forename: E F
authors.initials: EF
authors.lastname: Holland
mesh_terms: D000284:Administration, Oral; D000328:Adult; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009640:Norethindrone / Q000627:therapeutic use; D011293:Premenstrual Syndrome / Q000188:drug therapy*; D045167:Progesterone Congeners / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
chemical_list: D003692:Delayed-Action Preparations; D045167:Progesterone Congeners; D017273:Goserelin; D004958:Estradiol; D009640:Norethindrone