Gonadotropin-releasing hormone agonist (GnRH-a) for severe PMS

Examples

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Brand Name	Generic Name
Zoladex 3-month	goserelin acetate

Brand Name	Generic Name
Lupron Depot	leuprolide acetate

Brand Name	Generic Name
Synarel	nafarelin acetate

Leuprolide is given as a shot under the skin once a day or as a shot in the muscle every 1 to 3 months.

Nafarelin is a nasal spray used twice a day.

Goserelin is injected into the fat tissue of the abdomen once every 28 days.

How It Works

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Gonadotropin-releasing hormone agonist (GnRH-a) medications reduce the amount of estrogen in the body and prevent the release of eggs from the ovaries (ovulation). This stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.

Why It Is Used

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Rarely, GnRH-a medications are used to treat multiple severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) symptoms if other treatments have failed.

On the rare occasion that a woman is considering removal of the ovaries (oophorectomy), GnRH-a treatment is used beforehand. If GnRH-a treatment relieves symptoms, then removal of the ovaries is likely to provide complete relief from PMS. However, even if symptoms improve during GnRH-a treatment, it is possible that the medication is not the reason for the improvement.

A GnRH-a may be used only for short periods of time (3 to 6 months).

How Well It Works

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When effective, GnRH-a treatment almost completely ends physical and psychological PMS or PMDD symptoms. (The effectiveness of the nafarelin nasal spray can be hard to predict.) But, GnRH-a side effects are usually severe.

Side Effects

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GnRH-a medications produce a condition similar to menopause, with many of the same side effects. These side effects, which will go away or reverse themselves when you stop taking the medication, include:

• Absence of periods (amenorrhea).
• Hot flashes.
• Mood swings.
• Vaginal dryness.
• Decreased sexual interest.
• Loss of bone density.
• Acne (with nafarelin use).
• Nasal irritation (with nafarelin use).
• Lower urinary tract symptoms (with goserelin use).
• Increased total cholesterol level.
• Decreased high-density lipoprotein (HDL) cholesterol.

Women frequently become depressed or anxious when they first begin GnRH-a treatment.

Loss of bone density, which can lead to osteoporosis, is probably a reversible side effect if a GnRH-a is used only for short-term treatment (less than 6 months). If GnRH-a treatment is used for longer than 6 months, bone density loss may be permanent and may increase your risk for bone fractures later in life.

Though you are not likely to become pregnant while taking this medication, GnRH-a medication may affect a developing fetus. It is therefore necessary to use a birth control method while taking a GnRH-a.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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GnRH-a treatment usually stops menstrual periods. If regular periods continue, call your health professional.

GnRH-a treatment may be considered only after all other PMS treatments have failed.

Be sure to consider your risk for bone loss (osteoporosis) before starting GnRH-a therapy. If you are at high risk:

• Consider a different drug treatment.
• Avoid repeat GnRH-a therapy. If a second course of GnRH-a treatment is recommended, wait at least 1 year before starting it.

The benefits and effectiveness of GnRH-a need to be compared with the side effects and costs of treatment. You can discuss this with your health professional.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Credits

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Author	Sandy Jocoy, RN
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Last Updated	June 19, 2008