B Naheed
A systematic review – ovarian suppression with GnRH analogues for management of PMS
Naheed, B; Kuiper, JH; O'Brien, S
Abstract
Introduction Premenstrual syndrome (PMS) is a psychological and somatic disorder.It occurs in about 5–8% of women .PMS symptoms recur during the luteal phase of the menstrual cycle and remit by the end of menstruation. Premenstrual Disorders have a devastating effect on patients, their families and their work. The etiology of PMS is unknown but is almost certainly due to the effect of ovulation and CNS sensitivity to progesterone, thus treatment aims either to modulate CNS responsiveness or suppress ovulation.
Objectives Possible approaches to suppress ovulation include GnRH analogues, Danazol, estrogen and bilateral oophorectomy. We have published Cochrane reviews on SSRIs and ovulation suppression with non-contraceptive estrogen. There have been previous publications on GnRH analogues and there is comprehensive meta-analysis. No Cochrane review or other up to date systematic review has been published though we have published the Cochrane protocol.
Here we show preliminary findings which will lead to Cochrane systematic review of GnRH analogues (agonist and antagonists) with and with out add back. We speculate also on the need for scientific validation of the widely used ‘GnRH test’.
Methods We used the following computerised bibliographic databases to identify potentially relevant published clinical trials of GnRH analogues in the management of PMS.EMBASE, CENTRAL, MEDLINE, Psycho-info, Cochrane, CINAHL, unpublished studies, ongoing trials, conference abstracts, grey literature and the Cochrane Central Register of Controlled Trials. We used specific MeSH headings and additional keywords to identify relevant studies. The selection process documented with a ‘PRISMA’ flow chart.
Result Fourteen randomised studies against placebo were identified fulfilling our search criteria.
Long acting GnRH analogues are in widespread use for managing PMS. There is persuasive evidence (meta-analysis) that these preparations are very effective.
The ‘GnRH Test’, increasingly considered by gynaecologists to be very important prior to counselling for surgery, remains to be proven scientifically
Conclusion
There are relevant publications since the Lancet review (Wyatt et al 2004).
GnRH therapy appears effective.
Add back does not impede the positive effects of GnRH analogues.
No studies were identifies investigating GnRH as a test.
The clinical use of ‘the GnRH test’ needs formal validation.
Recommendation New studies are justified –Particularly.
For ‘GnRH test’.
For women whom PMS is re-introduced during add back therapy.
Continued need for RCTs with longer therapy and longer follow-up.
For comparative analysis these should be based on diagnostic criteria and trial design of the International Society for the Study of Premenstrual Disorders (ISPMD).
Citation
Naheed, B., Kuiper, J., & O'Brien, S. (2016). A systematic review – ovarian suppression with GnRH analogues for management of PMS. BJOG: An International Journal of Obstetrics and Gynaecology, 123, 186. https://doi.org/10.1111/1471-0528.14109
Journal Article Type | Article |
---|---|
Online Publication Date | Jun 16, 2016 |
Publication Date | 2016-06 |
Deposit Date | Jun 7, 2023 |
Journal | BJOG: An International Journal of Obstetrics & Gynaecology |
Print ISSN | 1470-0328 |
Publisher | Wiley |
Peer Reviewed | Peer Reviewed |
Volume | 123 |
Pages | 186 |
DOI | https://doi.org/10.1111/1471-0528.14109 |
Keywords | Obstetrics and Gynecology |
Additional Information | Conference information containing multiple articles under the same DOI. |
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