Although progestogens have been prescribed for PMS for over 35 years, the British Medical Association does not officially recommend them for the treatment of PMS.
However, many women say progesterone or progestogen has worked for them, although many other women have not found it helpful.
Progestogens can cause side effects such as: itchy skin; worsening of certain types of migraine and epilepsy; acne; weight gain; digestive disorders; depression; irregular periods; changes in sex drive; breast discomfort; insomnia; hair loss; excess hair growth; and worsening of premenstrual symptoms.
If you have a history of colitis, you should not use rectal suppositories, and women with vaginal infections and recurrent cystitis should not use vaginal pessaries.
Progestogens are taken a few days before premenstrual symptoms are expected and stopped when menstruation begins. The doses should be tailored to suit the individual woman. For progesterone suppositories and pessaries (Cyclogest is the trade name), the dose varies from 200 to 800 mg daily. For progesterone injections (Gestone is the trade name), women are started on 5 or 10 mg daily. Duphaston is prescribed in doses of 10 mg twice daily and increased if necessary.
Contraceptive Pill
If you choose the Pill as your method of contraception, you might find that it clears up your premenstrual symptoms, especially depression, irritability and anxiety, or you might find that your symptoms get worse. This is common among younger women.
Some studies show that the progestogen-only pill helps premenstrual symptoms.
Hormone Replacement Therapy (HRT)
Some researchers think that a lack of oestrogen (rather than progesterone) is the problem behind PMS. Studies have found that some women benefit from hormone replacement therapy, either in the form of oestrogen implants or patches, combined with seven days a month of oral progestogen. The oestrogen stops ovulation, and the progestogen causes a monthly bleed and protects you from endometrial cancer. This treatment is only for women with severe PMS and requires close supervision by a gynaecologist. There are increased risks of breast cancer and blood clots with long term use of HRT. For more information see the Women's Health leaflet on Hormone Replacement Therapy.
Bromocriptine
(Trade name Parlodel). This is used mainly as treatment for premenstrual breast pain. Possible side effects include nausea, vomiting, dizziness, and lower blood pressure. It is worth trying evening primrose oil first.
Danazol
(Trade name Danol). This is a powerful hormonal drug used for the treatment of endometriosis, breast pain, heavy bleeding, and other menstrual problems. It commonly produces disturbing side effects such as nausea, swollen feet/ankles, weight gain, acne/oily skin, and excess body hair. Because of these side effects, other treatments should be tried first.
Diuretics
(Trade names Navidrex, Moduretic, Saluric, Lasix). These are used for weight gain associated with bloating and swelling, but not for other symptoms. They are an artificial way to make your kidneys excrete more fluid but you run the risk of excreting too much potassium. There are side effects and they shouldn't be taken long term.
A study of 38 women showed that a daily supplement of 200 mg of magnesium reduced mild premenstrual fluid retention.
Mefenamic Acid
(Trade name Ponstan). This is a painkiller and can be used for headache, muscle, joint or period pain.
Antidepressants
Recent studies have shown that the more modern antidepressants, for example the selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, can help with the emotional symptoms of PMS, particularly in women who also have an underlying depressive illness.
GnRH agonist analogues
(e.g. Zoladex) These drugs are used to treat endometriosis, but also relieve PMS because they stop the ovaries from functioning. However this also causes menopausal symptoms, so these drugs are only given for six months. After treatment stops, the symptoms of PMS return.
Light therapy
Researchers at the Royal Postgraduate Medical School in London claim success in treating PMS with a light mask. The treatment involves wearing a mask for 15 minutes each day. The mask contains miniature lights, one in front of each eye, which gently flicker in pre-programmed rhythms. It is believed that the light therapy re-sets the body's internal clock, which becomes de-synchronized during PMS. In the London study, 12 out of the 17 participants no longer had PMS after using the mask for six months.
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Progesterone
