The exact hormonal connection concerning effects on PMS have been debated back and forth. Primary hormonal finding are that estrogen levels are elevated and plasma progesterone levels are reduced 5-10 days prior to menses. In addition to this hypothyroidism and mildly elevated prolactin levels are common. This being the findings you would think that just replacing progesterone would improve all the symptoms but controlled clinical trials have failed to consistently demonstrate the superiority of progesterone over placebo. This being said the studies that have showed some improvement have used extremely large doses of progesterone from day 14 to start of menses. In our clinic if other means of therapy doesn't work we then go ahead and use sublingual progesterone drops, which reach peak levels fairly rapidly within 30 minutes, and we know more or less right away if progesterone will be of any assistance to reduce PMS symptoms.

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