Gonadotropin-Releasing Hormone Agonist (GnRH-a) for Severe PMS

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Gonadotropin-Releasing Hormone Agonist (GnRH-a) for Severe PMS


Generic NameBrand Name

Leuprolide is given as a shot under the skin or as a shot in the muscle.

Nafarelin is a nasal spray.

Goserelin is injected into the fat tissue of the belly.

How It Works

Gonadotropin-releasing hormone agonist (GnRH-a) medicines 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

In rare cases, GnRH-a medicines are used to treat multiple severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) symptoms if other treatments have failed.

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. But even if symptoms improve during GnRH-a treatment, it is possible that the medicine 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.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Hives.
  • Swelling of your face, lips, tongue, or throat.
  • A fast or irregular heartbeat.
  • Bone, muscle, or joint pain.

Call your doctor if you have:

  • Anxiety, depression, or other mood changes.
  • Bleeding between menstrual periods.

Common side effects of this medicine include:

  • An irregular menstrual period (or no menstrual period at all).
  • Hot flashes.
  • Vaginal burning, itching, or dryness.
  • Decreased sexual interest.
  • Thinning of the bones.
  • Increased acne or oily skin or hair.
  • An irritated or runny nose (nafarelin only).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

These medicines are given as a shot or a nasal spray. You will get instructions on how to give the shot or use the nasal spray. Ask your doctor or pharmacist if you have any questions about how to take your medicine correctly.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to take this medicine, talk to your doctor about how you can prevent pregnancy.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.


By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Kirtly Jones, MD, MD - Obstetrics and Gynecology
Last Revised July 26, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.