I think what Studd means is that's the level required to suppress ovulation - the aim for someone with fluctuating hormone levels. With someone in menopause, it's different as your own estrogen isnt mucking around behind the scenes, so all you need is a top up. I think that's why so many of us in peri menopause have struggled with hrt. It's also the reasoning behind the birth control pill Qlaira.
This is from his website (two places) as what I've said above is a bit waffled!
As the ultimate cause of PMS is ovulation, it follows that the logical cure should be suppression of ovulation. Certainly this achieved by pregnancy, surgery or waiting for the menopause, but a more straightforward medical therapy should be considered.
There are now many studies showing that GnRH analogues remove the symptoms of PMS by suppressing ovulation and producing a medical menopause. An injection of Gonapeptyl, every month is ideal and 'add-back' HRT, will prevent vasomotor symptoms and bone demineralisation. The orthodox estrogen/progestogen preparations are useful but the PMS symptoms may recur with the cyclical progestogen. Livial seems to be an excellent alternative without bleeding or progestogenic side effects.
Ovulation can also be suppressed by moderately high dose transdermal oestrogens in the form of oestradiol patches or oestradiol gel. Appropriate doses would be a 200ugs oestradiol patch or 2 or 3 doses of oestrogel twice daily. Woman may occasionally feel a little worse in the first two weeks on this high dose, like an early pregnancy, but should be advised to continue as substantial benefit is almost certain if the diagnosis is correct. A longer term therapy would be a 75mgs estradiol implant inserted every 6 months. This like the patches and the gel will produce plasma estradiol levels of about 600pmol/L and abolish ovulation in most cases. However, women should be advised that this will not be used as contraception, as the appropriate tests have not yet been carried out.
Premenstrual syndrome is a common and sometimes severe group of cyclical symptoms with distressing physical and psychological symptoms that can seriously effect a woman's well being. These symptoms follow the hormonal changes (whatever they are-probably progesterone) that occur with and following ovulation. Therefore, these cyclical PMS type symptoms do not occur before puberty, after the menopause, during pregnancy, or after hysterectomy and bilateral salpingo oophorectomy. However, the typical cyclical symptoms do remain after a hysterectomy if the ovaries are conserved. Thus, menstruation is not a necessary feature for this condition and it would be more meaningful if the disorder was called the ovarian cycle syndrome (1).
In spite of frequent usage there is no evidence that progesterone is effective for treatment but there is ample evidence that progestogen makes the condition worse. Proven hormonal therapy for this condition is based upon suppression of ovulation. These are:
GnRH treatment over 3-6 months (2). This confirms the diagnosis and removes the symptoms but it is not appropriate for long term therapy without add back oestradiol and progestogen. The progestogen will reproduce the PMS symptoms as these patients are progestogen/progesterone intolerant.
Suppression of ovulation by transdermal oestrogens in the dose of 100µg or 200µg of oestradiol patch (3). Such patients also need cyclical progestogen for 7-10 days a month or insertion of a Mirena IUS.
Hormonal implants of oestradiol with the addition of testosterone (4) if necessary in the presence of loss of energy, loss of libido and depression. The same protection of the endometrium by progestogen tablets or a Mirena IUS is necessary.
Hysterectomy and salpingo oophorectomy with appropriate long term hormonal replacement therapy (5). In those rare patients with bleeding problems or progestogen side effects in spite of the use of a Mirena IUS.
The birth control pill, although it suppresses ovulation, is not usually effective because the progestogen component produces the PMS symptoms for most of the month rather than half of the month.
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