Gonadotropin-releasing hormone agonist (GnRH-a) for severe PMS
|Generic Name||Brand Name|
|goserelin acetate||Zoladex, Zoladex 3-month|
|leuprolide acetate||Lupron Depot|
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
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
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
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.
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
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.
Last Updated: June 19, 2008
Author: Sandy Jocoy, RN