Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Segebladh
Birgitta
B
Department of Women's and Children's Health, Uppsala University, University Hospital, Uppsala S-751 85, Sweden. birgitta.segeblad@lvn.se
Borgström
Anna
A
Nyberg
Sigrid
S
Bixo
Marie
M
Sundström-Poromaa
Inger
I
D000328:Adult; D000339:Affect / Q000187:drug effects; D001007:Anxiety / Q000188:drug therapy; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects; D016729:Leuprolide / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy*; D010919:Placebos; D011293:Premenstrual Syndrome / Q000188:drug therapy*; D011374:Progesterone / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D010919:Placebos; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D016729:Leuprolide