BMJ  2003;327:E78 (4 October), doi:10.1136/bmjusa.01110004 (published 4 September 2002)

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

This article originally appeared in BMJ USA

As of November 13, five rapid responses had been posted on bmj.com in response to the paper by Wyatt et al, along with several replies from the investigators. One rapid response is reproduced below; the others can be found at http://bmj.com/cgi/eletters/323/7316/776.—EDITOR

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Topical progesterone for cyclic mastalgia

This article originally appeared in BMJ USA

Editor—As a nurse-midwife, I routinely perform gynecologic exams. Through my own personal struggle with one particularly common symptom of premenstrual syndrome (PMS), cyclic mastalgia, I have discovered that topically applied micronized progesterone cream is highly effective for myself and for my patients who suffer from this condition. In my clinical experience, it is equally effective for peri-menopausal cyclic mastalgia.

I find it perplexing that topical treatment is apparently effective (at least in my clinical practice) when the literature on progesterone supplementation clearly suggests no positive effect on PMS. I would suggest a study exploring the topical route of supplementation for PMS before abandoning a possible treatment for a common disorder for which we have so few acceptable treatments.

In reply—To our knowledge, no randomized controlled trial has assessed the use of topical progesterone for cyclic mastalgia, so we can only comment that the treatment remains of unknown effectiveness.

LaSalle, Illinois, USA otissam{at}aol.com

Keele University and North Staffordshire Hospital, Stoke-on-Trent, UK oga03{at}keele.ac.uk

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