Systematic reviews of the management of premenstrual disorder through the elimination of ovulation

Abstract

Premenstrual syndrome (PMS) is a distressing psychological and somatic disorder of unidentified aetiology occurring during the luteal phase of the menstrual cycle. This thesis includes systematic reviews of the published literature on the therapeutic effect of surgical and hormonal suppression of ovulation in the management of premenstrual disorders. Both approaches use the principle that elimination of ovulation removes premenstrual symptomatology along with its consequences.
Oestrogen treatment eliminates ovulation, but the necessity for progestogen to prevent endometrial hyperplasia may limit its use. Whilst there are several published trials of the use of oestrogen to treat PMS, this is the first systematic review aiming to evaluate the effectiveness and safety of non-contraceptive oestrogen-containing preparations (oral, patch, implant and gel) in managing PMS. The use of oral contraceptives to treat PMS lies outside the scope of this review.
Gonadotropin-releasing hormone (GnRH) agonists also suppress ovarian function and have been found to reduce premenstrual symptoms in virtually all studies. Hypo-oestrogenic side effects may limit their use in clinical practice. Ours is the first Cochrane systematic review of the therapeutic effectiveness of GnRH analogues (agonists and antagonists) in the management of PMS. The only existing systematic review on the topic can be considered outdated.
Surgical approaches that eliminate menstruation or ovulation have been reported to treat PMS symptoms. Surgery is an important option for the management of patients with severe premenstrual disorders who have failed to respond to other treatments. However, it is uncertain whether these invasive procedures are justified by the symptomatic relief obtained. Ours is the first systematic review aiming to assess the outcomes and safety of surgical interventions in the management of PMS.
To help future clinical trial design, an online survey was conducted collecting the experiences and preferences of women suffering from PMS regarding treatment options and their expectations about the need for and taking part in research studies.