Premenstrual Syndrome - Medications

Buspirone. Buspirone (BuSpar) is a unique anti-anxiety agent known as an azapirone. A 2001 study reported that it reduced premenstrual irritability. Unlike the benzodiazepines, buspirone is not addictive. Buspirone also seems to have less pronounced side effects than benzodiazepines and no withdrawal effects, even when the drug is discontinued quickly. Common side effects include dizziness, drowsiness, and nausea.

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Hormone Therapies

Although hormone therapies are often prescribed for PMS, evidence suggests that they have little effect on these symptoms except in some cases. For example, some reports indicate that they may be helpful in women with asthma for reducing wheezing during the premenstrual period.

Hormonal Contraceptives. Although oral contraceptives (OCs) are sometimes prescribed for PMS symptoms, there is limited evidence that they actually help. Older studies indicated that while OCs may improve physical symptoms, they may worsen mood symptoms. New types of OCs are now being developed to specifically treat the mood symptoms associated with premenstrual dysmorphic disorder (PMDD).

Most OCs combine progestins (either natural or synthetic forms of progesterone) and estrogen. A new low-dose OC (Yaz) is currently being studied for treatment of PMDD. It contains the estrogen estradiol and a newer progestin called drospirenone. In a 2005 study, this OC improved mood and reduced PMDD symptoms. Side effects included bleeding between menstrual cycles and nausea. At the time of this report, the FDA was considering approving Yaz for the United States market. .

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Side effects of OCs include nausea, breakthrough bleeding, breast tenderness, headache, and weight gain. Certain women should avoid oral contraceptives or use them with caution.

GnRH Analogs. Potent hormonal drugs called gonadotropin-releasing hormone (GnRH) agonists suppress ovulation and, thereby, the hormonal fluctuations that produce PMS. They are sometimes used for very severe PMS symptoms and to improve breast tenderness, fatigue, and irritability. (These drugs, in fact, are sometimes used to rule out or confirm a diagnosis of PMS. If symptoms persist while the drug is being taken, then PMS is unlikely to be their cause.) GnRH analogs, however, appear to have little effect on depression.

They include nafarelin (Synarel), goserelin (Zoladex), leuprolide (Lupron Depot), and histrelin (Supprelin). Some experts believe that GnRH analogs may be useful as first line therapy in some women with menstrual pain and irregular periods. These drugs are also effective for relieving symptoms of severe PMS, endometriosis, fibroids, and menorrhagia.