Gonadotrophin-releasing hormone (GnRH) analogues. These drugs are used for the most severe cases and work by blocking the pituitary hormones that trigger the menstrual cycle. In effect they produce a sort of mini-menopause because no oestrogen is produced by the body.
To prevent long-term problems caused by lack of oestrogen – such as weak bones and raised cholesterol levels – oestrogen therapy is usually prescribed at the same time.
GnRH analogues are given as a nasal spray or long-acting injection.
Doctors who use this therapy say it can be invaluable in women whose marriages are deteriorating as a direct result of PMS as it can give a break from symptoms. The other advantage is that the break from symptoms shows the woman and her family that there is a biological explanation for the symptoms and that they are not due to psychiatric or personality disorders.
Surgery. Surgery (hysterectomy) is an extremely rare treatment for PMS and not one to be taken lightly. It involves removing the womb and the ovaries, resulting in instant menopause. Oestrogen replacement therapy is needed for life after this type of surgery.
It should only be considered as a last-ditch attempt at solving really serious PMS.
Hysterectomy is a major step so if your doctor refers you to a surgeon who offers this option you should take time to think and discuss the implications with your partner. If you are not sure, it is definitely worth getting a second opinion from another doctor before agreeing to anything.