Chapter 29: Premenstrual Syndrome: Evaluation and Treatment

Thomas W Hilgers

Reproductive Endocrinology · Luteal Phase

Chapter 29: Premenstrual Syndrome: Evaluation and Treatment

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 345-368, 2004

RRM Academy Synopsis

PMS improved in most treated women on cycle-timed hormone support

A NaProTECHNOLOGY textbook chapter reports that most women treated for premenstrual syndrome improved when hormone support followed their charted cycle. Five of six progesterone trials, which used calendar timing, found no benefit. The chapter presents data on 147 women with PMS, and 88 of them received treatment.

Key Findings

Of six double-blind, placebo-controlled progesterone trials in premenstrual syndrome, five found no improvement. The one trial reporting benefit timed progesterone to confirmed ovulation.
Ovulation occurred by cycle day 14 in 34.7 percent of cycles and later in 65.3 percent. Progesterone started on day 16 therefore precedes ovulation whenever ovulation falls after day 16.
Compared with 22 controls, 77 women with PMS had significantly lower progesterone on later sampling days after Peak Day. Beta-endorphin was significantly lower on a later sampling day among 57 women.
A double-blind, placebo-controlled crossover trial of naltrexone, an opioid receptor blocker, reported a significant decrease in luteal-phase symptoms. The trial followed reports of low beta-endorphin in PMS.
Most of the 88 women given targeted hormone support improved markedly or moderately. The improvement rate with targeted progesterone or HCG support significantly exceeded that in the fluoxetine product literature.

RRM Context

Restorative reproductive medicine asks what the cycle is doing and when, then treats that cause. In NaProTechnology, charting with the Creighton Model FertilityCare System marks Peak Day, and hormone testing and support follow each woman's own ovulation. Charting turns a vague complaint into a timed observation. Evaluation precedes treatment, so her pattern is known before therapy begins. The chapter reports similar premenstrual symptoms in women with infertility and in women with spontaneous abortion. It raises the possibility that the three conditions share a common cause.

Our editorial summary of this paper, not the article's abstract.

Abstract

Premenstrual syndrome in NaProTECHNOLOGY is defined by a recurrent cluster of symptoms -- including irritability, breast tenderness, bloating, depression, and carbohydrate craving -- beginning at least four days before menses, and is associated with late-luteal deficiencies in progesterone, estrogen, and beta-endorphin identified through CrMS-anchored hormone profiling. Treatment with cycle-synchronized bioidentical progesterone, targeted HCG injections to stimulate endogenous corpus luteum function, and low-dose naltrexone to modulate opioid dynamics produces superior symptom resolution compared to SSRI therapy in Hilgers' comparative data, without suppressing ovulation.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Premenstrual Disorders › Premenstrual Syndrome Treatment · Therapeutics › Hormonal Agents › Progesterone and Progestins

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 29: Premenstrual Syndrome: Evaluation and Treatment

PMS improved in most treated women on cycle-timed hormone support

Key Findings

RRM Context

Abstract

Topics

By this author

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