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Gonadotropin-releasing hormone (GnRH) analogues for premenstrual syndrome (PMS)

Naheed B, Kuiper JH, O'Mahony F, O'Brien PM

The Cochrane database of systematic reviews, 2025

275 participants · 5 citations

Abstract

Background: Premenstrual syndrome (PMS) is a psychological and somatic disorder affecting 20% to 30% of women of reproductive age. PMS results from ovulation: symptoms recur during the luteal phase of the menstrual cycle and remit by the end of menstruation. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS experienced by three to eight per cent of menstruating women. In this review, we use the term PMS to cover all core premenstrual disorders, including PMDD. The symptoms of all types are severe enough to affect daily functioning, interfering with work, school performance or interpersonal relationships. Gonadotropin-releasing hormone (GnRH) analogues are a pharmacological treatment to suppress ovulation. They can be administered as GnRH-agonists or GnRH-antagonists, though currently, GnRH-antagonists are not generally used to treat PMS. Suppressing ovarian function induces a hypo-oestrogenic state that can cause menopausal side effects such as hot flushes and mood changes. Having menopausal side effects instead of PMS symptoms can be distressing and can confuse clinical management. Longer-term GnRH therapy carries the risk of osteoporosis. To counteract these adverse effects, oestrogen or progestogen can be added to the PMS treatment; this is known as 'add-back' therapy or simply 'add-back'. Add-back may reduce menopausal side effects, allowing GnRH therapy to be used for a longer period without reducing efficacy.

Objectives: To evaluate the therapeutic…

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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 275 participants or records.

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