Indications for drug therapy in premenstrual syndrome patients

Women with mild to moderate premenstrual syndrome (PMS) should have their symptoms controlled with conservative therapy, including diet, exercise, education and nutritional supplementation. Those patients with moderate to severe PMS whose condition cannot be controlled in this conservative fashion should undergo pharmacologic trials. Recent studies of progesterone supplementation showed no improvement when it was compared to placebo; the one exception was the use of oral micronized progesterone one therapy at a level of 300 mg/day, but the study remains to be repeated by other investigators. The most logical therapy at present is suppression of ovulation with a short-term trial of danazol, perhaps followed by long-term suppression with estrogen implants or depomedroxyprogesterone acetate. Surgical ovariectomy is warranted in a very small number of cases. Prostaglandin inhibitors are effective for the physical complaints that may be associated with PMS. Some antihypertensive agents, such as clonidine and verapamil, which are also antimania drugs, may have a place in the treatment of PMS.