What is the best treatment approach for aphthous ulcers that recur with menstruation?—REBECCA S. SMITH, MD, Greenville, S.C.

This topic has been the subject of some controversy. McCartan and Sullivan examined the postulated associations between recurrent aphthous stomatitis and the menstrual cycle, pregnancy, and menopause (Obstet Gynecol. 1992;80:455-458). Their goal was to determine why such associations had been accepted previously in the absence of convincing evidence. In the literature, they discovered one retrospective study on aphthous ulceration and ovarian hormones, eight prospective studies, three uncontrolled trials on the use of hormones in aphthous stomatitis, one controlled trial, and four review papers. These studies showed no established associations between aphthous stomatitis and the premenstrual period, pregnancy, or menopause. In addition, they concluded that no properly designed study has shown a therapeutic effect of ovarian hormones on aphthous stomatitis. Therefore, at this time, I can make no specific recommendations for aphthous ulcers that recur with menstruation. Traditional therapies appear to be the best options.—Jeffrey M. Weinberg, MD쇓(149-9)