Not reported

Oestrogen deficiency syndrome

Oestrogenic effects

Oestrogen dependent tumors thrombophlebitis or embolism Otosclerosis undiadignosided genital bleeding endometriosis porphyria hepatic dysfunction disturbed lipid metabolism pregnancy lactation

Special precautions:

Thrombotic phenomena surgery.smoking high dose , prolonged use undiagnosed vaginal bleeding hypertension diabetes, migraine metabolic bone disease

Oestrogen deficiency syndrome

Dosage-

4mg daily in 1st week reduce gradually in next 2 weeks maintenance 1-2mg daily

EVIDENCE BASED MEDICINE (April 2003)

Premenstrual sydrome

Comparative effectiveness of various intreventions

Beneficial

Overall Premenstrual Syndrome

Symptoms

1. Prostagalndin inhibitors (e.g. Indomethicin) 2. Selective serotonin Reuptake Inhibitors (e.g. Fluoxetine, Seratinine, Fluvoxamine) Breast symptoms only

1. Leuteal phase control

. Bromocriptine Bloatedness and Swelling

1. Spironolactone/ diuretics

Likely to be beneficial

1. Tobolone

2. Oestrogen

3. Vitamin B-6

4. Evening primrose B-6 Trade-off between Benefits and

Harms

1. Danazol

2. Gonodotropin-releasing hormone (GnRH analogues)

3. Non-SSRI antidepressants/ anxiolytics

4. Hysterectomy with/without oophorectomy

Unknown effectiveness

1. Progesterone

2. Progestogens

3. Oral contraceotives

4. Cognitive behaviour treatment

5. Dietary supplements

6. Relaxation treatment

7. Endometrial ablation

8. Laproscipic bilateral oophorectomy

KEY POINTS

1. Trials have found that SSRIs and prostagalndin inhibitors relieve premenstrual symptoms. Antidepressants and ovulation suppression with danazol and GnRH analoges are also effective but have significant adverse effects, including the masculanising effects of danazol and the menopausal effects of GnHR analogues.

2. There is a limited evidence suggesting that oestrogen, viatmin-B6 , evening Primrose Oil and excercise may also be beneficoial

3. Trials have found that bromocriptine is effective for breast symptoms and diuretics are effective for bloatedness and swelling. Both can have adverse efects.

4. There is no good evidence to support the use of progesterone or oral contraceptives

5. Few treatments have been adequately validated in trials.

Use contraindicated . Observe caution