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Dx Premenstrual Symptoms/ Seizures/ Behavior Changes Treatments:

Severe PMS: PMDD

Medications Used in Treatment:
1. SSRIs: Zoloft®/sertraline, Paxil®CR/paroxetine er, Sarafem®/fluoxetine
2. Estrogen/Progestin Combinations: Yaz®/drospirenone, ethinyl estradiol; see list
3. Androgens: Danocrine®/danazol, testosterone, nandrolone, oxandrolone, stanozolol
4. Aldosterone Antagonist: Aldactone®/spirolactone
5. IUD: Mirvena®
6. Progestins/ Progesterone: Bio-identical progesterone

*[Editor] "Two treatment modalities distinguish themselves as highly effective: suppression of ovulation and specific serotonin re-uptake inhibitor (SSRI) antidepressants. Suppression of ovulation is effective for a wide range of PMS, while SSRIs are effective for PMDD... The SSRIs are also efficacious when administered intermittently--only during the luteal phase of the menstrual cycle." The Editor prefers to first use hormonal suppression with danazol or mixed androgen injections because these two modalities have controlled the seizures, severe menstrually related disorders outlined by Deeny below, and the emotional roller-coaster symptomatology.

[Editor] Deeny in a double-blind study published data showing major improvement in Pre-Menstrual Syndrome symptoms with the use of danazol 100mg twice daily. These beneficial effects were noted even as menstruation continued.

Symptom Danazol group (n=30) Placebo group (n=29) Statistics
Breast Discomfort 2.9 20.9 P< 0.01
Irritability 6.9 22.1 P< 0.01
Depression 2.9 12.9 P< 0.01
Anxiety 3.8 12.9 P< 0.05
Mood swings 1.8 12.6 P< 0.01
Depressed libido 33.6 57 P< 0.01
Abdominal swelling 4.7 515.7 P< 0.01

[Editor] In similar manner to Danazol, lowering the estrogen levels and raising the Free Androgen Index (testosterone/SHBG) with the mixture of nandrolone and stanozolol has been effective in many women who did not tolerate or benefit from danazol therapy. Case Report: Denise at 28 developed post-partum catamanial epilepsia, PMS and migraine unresponsive to anti-epileptic medications. Treatment was started with Danazol 400mg daily and increased to 1200mg daily. Denise remains seizure free 30 years later. Well into the menopause, Danazol was discontinued without return of seizures or other hormonal mitigated symptoms.

[Editor] While there are published reports of performing total hysterectomy and oophorectomy for the most severe PMS, the experience with mixed androgen injections may make this practice obsolete.

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