Dr. John Studd
clinical gynaecologist

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Menopause and PMS Clinic: PMS

Pre-menstrual syndrome is a very complex condition which is frequently difficult to treat. Mild PMS is very common and responds to many scientifically unproven treatments or to change of lifestyle and diet. There is also an impressive placebo response. Severe PMS is the sort that destroys careers and marriages is paradoxically easier to treat because the severity requires proven treatment administered by a medical practitioner. These treatments essentially rely on suppression of ovulation and thus removing the hormonal changes (whatever they are) of the ovarian cycle and hence removing the cyclical symptoms of PMS. The sort of treatments include use of moderately high dose oestradiol patches, (Fig 4) oestradiol implants, GnRH analogues with add-back HRT or even, if appropriate, total abdominal hysterectomy and bilateral salpingo-oophorectomy with hormone replacement therapy. The role of SSRIs anti-depressants should not be ignored, possibly in combination with transdermal oestrogen therapy.