Role of danazol in relieving the premenstrual syndrome.

Approximately 90% of women experience some symptoms of the premenstrual syndrome (PMS); in up to 40% of cases the symptoms are moderate to severe. The signs and symptoms of PMS usually wax and wane according to a four-phase temporal pattern. Within this overall schema there are a number of PMS subtypes. PMS typically manifests before the age of 30 and rarely resolves spontaneously. While genetic factors may play a role in the development of PMS, other epidemiologic factors do not seem to be involved. Various pathophysiologic mechanisms have been proposed as causing PMS. They are an estrogen/progesterone imbalance, prolactin abnormalities, fluid retention, abnormal production of certain prostaglandins, hypoglycemia, pyridoxine deficiency and shifting levels of endorphins. However, the role of these factors in the etiology of PMS has not been established definitively; thus, treatment remains largely empiric. The author's experience with the use of Danocrine (danazol) on 21 patients with PMS suggests that this synthetic steroid, when used in conjunction with nonpharmacologic treatment options, relieves the symptoms of PMS in up to 85% of patients. Women whose PMS is characterized primarily by mastalgia appear to respond most favorably to treatment; danazol is not recommended for women with primary depression or anxiety symptomatology.