Managing Resistant PMS and Persistent Progestogenic Side-Effects
When premenstrual syndrome does not respond to standard management, or when progestogenic side-effects persist and prevent continuation of ongoing therapy, a specialist-guided escalation pathway applies.
Clinical Situation
This protocol addresses women with PMS that has proved resistant to earlier measures, or in whom persistent side-effects from progestogenic therapy have become a limiting factor. Referral to a gynaecologist is indicated at this point before proceeding.
Treatment Approach (partial overview)
Management at this stage involves a class of hormonal agents that suppress ovarian cyclicity, used together with add-back hormone therapy to offset the effects of that suppression. Specific agent selection, the add-back regimen, and duration limits are detailed in the full protocol.
References
- GnRH analogues with add-back HRT are recommended for resistant PMS or persistent progestogenic side-effects.
- When treating women with PMS with GnRHa therapy, treatment should only be continued for 6 months when used alone.
- Treatment should be combined with HRT to reduce bone density loss.
- A recent meta-analysis of GnRH analogues has confirmed their efficacy compared with placebo.
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