Management of the Premenstrual Syndrome by Subcutaneous Implants of Oestradiol

The suppression of cyclical ovarian activity by subcutaneous implants of oestradiol has been used to treat the premenstrual syndrome (PMS) in 92 patients, including 16 who also suffered from menstrual migraine. The treatment, usually with an initial dose of 100 mg oestradiol, reduced to 50 mg every 6 months, has continued for upto 7 years, with a mean duration of therapy of 2.0 years; 80% of patients have had more than one implant, and 32% have had five or more. Complete or almost complete relief of the symptoms of the PMS was reported by 84%. Previous medication was reduced or discontinued by 83%. Of the 84% where a comparison could be made with previous treatments, 93% considered implant therapy to be the most effective.Progestogen was given cyclically, usually for 7-10 days each month, to induce regular withdrawal bleeding and prevent endometrial hyperplasia. This was associated with the return of the patients' characteristic premenstrual symptoms in 45%, but to a lesser degree and for a shorter duration than prior to implant treatment.We suggest that (1) PMS is a result of unspecified cyclical biochemical changes following ovulation, (2) the symptoms can be removed by subcutaneous oestradiol implants of a sufficient dose to inhibit cyclical ovarian activity, and (3) the symptoms can be reproduced by oral progestogens.