Hammarbäck, S., & Bäckström, T. (1988). Induced anovulation as treatment of premenstrual tension syndrome. A double-blind cross-over study with GnRH-agonist versus placebo. Acta Obstetricia Et Gynecologica Scandinavica, 67(2), 159-166. https://doi.org/10.3109/00016348809004191
Hammarbäck S, Bäckström T. Induced anovulation as treatment of premenstrual tension syndrome. A double-blind cross-over study with GnRH-agonist versus placebo. Acta Obstet Gynecol Scand. 1988;67(2):159-166. doi:10.3109/00016348809004191
Hammarbäck, Stefan, and Torbjörn Bäckström. "Induced anovulation as treatment of premenstrual tension syndrome. A double-blind cross-over study with GnRH-agonist versus placebo." Acta Obstetricia Et Gynecologica Scandinavica, vol. 67, no. 2, 1988, pp. 159-166.
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Nasal GnRH-agonist eased premenstrual symptoms more than placebo
A nasal GnRH-agonist improved premenstrual symptoms more than placebo in a double-blind cross-over trial of 26 women with premenstrual tension syndrome. Of the 23 who finished, about 6 out of 10 felt significantly better overall on the drug than on placebo. By the last treated cycle, fewer women on the drug still had cyclical symptom changes.
Key Findings
Of 23 women who completed the study, 14 (61%) felt significantly better overall on the GnRH-agonist than on placebo, 6 felt no difference, and 3 (13%) felt significantly worse.
During the premenstrual days, 17 of 23 women (74%) improved on the GnRH-agonist compared with placebo, and one became worse.
In the last treated cycle, 4 of 23 women still had significant cyclical symptom changes on the GnRH-agonist, against 12 of 23 on placebo.
Of 12 women with symptoms only in the luteal phase, 75% improved significantly on the GnRH-agonist compared with placebo, against 45% of 11 women who also had symptoms before ovulation.
Two women left within 14 days with severe premenstrual-like symptoms on the drug, and a third left with menopause-like symptoms. One woman who finished had a similar reaction.
Interpretation
The trial used a double-blind cross-over design. The 23 women who finished received both the GnRH-agonist and placebo, about three months each, and the authors compared ratings only within each woman. Symptoms also improved on placebo, which the authors call a very strong placebo effect. The 26 women came from one Swedish university hospital clinic and were followed for up to six months. The authors infer from the loss of cyclical symptoms that a factor from the corpus luteum is involved in cyclical mood changes.
RRM Context
A GnRH-agonist is a suppressive medication that inhibits ovulation. Restorative reproductive medicine evaluates symptoms in light of the ovulatory cycle. The trial rated symptoms every day for two cycles before treatment began. Cycle charting uses the same daily record.
Our editorial summary of this paper, not the article's abstract.
Abstract
A treatment with the GnRH-agonist, buserelin, was given intranasally in a dosage of 400 micrograms once daily, to induce anovulation in 26 women with premenstrual tension syndrome; 23 patients completed the study course. The design was double-blind and cross-over. Daily symptom ratings were made for two pretreatment, diagnostic cycles and continued for up to six cycles or 6 months. The rating scale used was an earlier described visual analogue scale. Blood samples for estradiol and progesterone radio-immunoassay were taken once weekly throughout the study. Results show beneficial effects of both placebo and GnRH-agonist, compared with the pretreatment situation. The GnRH-agonist was, however, significantly better than placebo. At the end of the treatment periods the patients while still taking placebo, still showed cyclical symptom changes, whereas during the GnRH-agonist treatment the cyclical changes had disappeared. The results indicate that a factor from the corpus luteum must be involved in the etiology of cyclical mood changes. The results also show that inhibition of ovulation by mean of GnRH-agonists is one possible way to treat premenstrual tension syndrome.
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