Therapeutic trials with bromocriptine in the premenstrual syndrome are based on the hypothesis that this condition is characterised by an increased luteal phase prolactin secretion, believed to be of importance in the aetiology and pathogenesis of the syndrome. Reviewing the literature does not substantiate this original hypothesis. Women with the premenstrual syndrome seem to have normal serum prolactin levels as well as normal thyrotrophin releasing hormone induced increments. This does not necessarily mean that bromocriptine is ineffective in the treatment of the syndrome, but knowledge of the pathophysiology of the premenstrual syndrome does not explain any therapeutic effect of the drug. This review covers 6 controlled trials of bromocriptine in 119 women with the syndrome. Although the studies do not give a uniform picture, the following view emerges: medication should be cyclical, begin around midcycle and continue until the onset of the menstrual flow. Despite rather frequent side effects, the dosage should not be less than 2.5mg twice daily, since there is no evidence of any therapeutic effect of smaller dosages. The efficacy of such therapy is not uniformly accepted, although a beneficial effect on premenstrual mastodynia is convincingly supported.
General guidelines to the management of the premenstrual syndrome in clinical practice are given.