ABSTRACT
We have seen in previous chapters that the underlying cause of premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD) remains unknown, although cyclical ovarian activity appears to be a key factor.1 A logical treatment, therefore, is to suppress ovulation and thus prevent the neuroendocrine changes that cause the distressing symptoms. The current therapy for PMS/ PMDD is varied and includes psychotherapeutic, cognitive, or hormonal. However, the cornerstone of hormonal treatment relies upon suppression of ovulation and removal of the hormonal changes that follow ovulation in the luteal phase. When there are no cyclical hormonal changes during pregnancy, not only are there no cyclical mood symptoms but also depression is uncommon. There then often follows an episode of postpartum depression when there is a fall of levels of placental hormones, with a recurrence of symptoms when the periods return.2
