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The Role of Hormones and Hormonal Treatments in Premenstrual Syndrome

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Abstract

Premenstrual syndrome (PMS) is a menstrual cycle-linked condition with both mental and physical symptoms. Most women of fertile age experience cyclical changes but consider them normal and not requiring treatment. Up to 30% of women feel a need for treatment. The aetiology is still unclear, but sex steroids produced by the corpus luteum of the ovary are thought to be symptom provoking, as the cyclicity disappears in anovulatory cycles when a corpus luteum is not formed. Progestogens and progesterone together with estrogen are able to induce similar symptoms as seen in PMS. Symptom severity is sensitive to the dosage of estrogen. The response systems within the brain known to be involved in PMS symptoms are the serotonin and GABA systems. Progesterone metabolites, especially allopregnanolone, are neuroactive, acting via the GABA system in the brain. Allopregnanolone has similar effects as benzodiazepines, barbiturates and alcohol; all these substances are known to induce adverse mood effects at low osages in humans and animals. SSRIs and substances inhibiting ovulation, such as gonadotrophin-releasing hormone (GnRH) agonists, have proven to be effective treatments. To avoid adverse effects when high dosages of GnRH agonists are sed, add-back hormone replacement therapy is recommended. Spironolactone also has a beneficial effect, although not as much as SSRIs and GnRH agonists

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Acknowledgements

This work has been supported by the Swedish Research Council, Medicine (Proj 4X11198), EU Regional Fund, Objective 1 and Umeå University research funds. The authors have no commercial interest in the paper or other conflicts of interest that are relevant to the content of this paper.

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  1. Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 85, Umeå, Sweden

    Torbjörn Bäckström, Lotta Andreen, Vita Birzniece, Inger Björn, Inga-Maj Johansson, Maud Nordenstam-Haghjo, Sigrid Nyberg, Inger Sundström-Poromaa, Göran Wahlström, Mingde Wang & Di Zhu

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  1. Torbjörn Bäckström
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Correspondence to Torbjörn Bäckström.

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Bäckström, T., Andreen, L., Birzniece, V. et al. The Role of Hormones and Hormonal Treatments in Premenstrual Syndrome. CNS Drugs 17, 325–342 (2003). https://doi.org/10.2165/00023210-200317050-00003

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