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During the second month, she experienced a major exacerbation of both symptoms center and in addition noted the development of increased perimenstrual pigmentation of her upper lip. I suspected that EPO in this patient was increasing the formation of PGs derived from AA, since PGF2. is a major mediator of dysmenorrhea and PGE2 is a positive feedback modulator of estrogen formation in the ovary. Blood for plasma phospholipid fatty acids was center drawn at this time. The patient was placed on a low-fat diet. EPO was discontinued and supplementation with LSO, 15 gm daily, and Max-EPA. 3 center gm daily, was begun. Within 2 months there was complete disappearance of premenstrual mastodynia and dysmenorrhea. The perimenstrual melasma. had also cleared. The patient began to complain of dry skin. The dose of Max-EPA was reduced to 2 gm daily, and EPO was reintroduced into the therapeutic regimen at a dose of 2 gm per day.
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