Premenstrual Syndrome - Medications

Highlights	Risk Factors	Other Treatments
Introduction	Complications	Medications
Symptoms	Treatment	Resources
Diagnosis	Lifestyle Changes	References
Causes	Therapy

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins, substances that dilate blood vessels and cause inflammation. NSAIDs are usually the first drugs tried for almost any kind of minor pain. There are dozens of NSAIDs. Aspirin is the most common. Among the most effective NSAIDs for menstrual disorders are ibuprofen (Advil, Motrin, Midol PMS), naproxen (Aleve, Naprosyn, Naprelan, Anaprox), and mefenamic acid (Ponstel). Studies have also indicated that they are most helpful when started seven days from menstruation and continued for four days into the cycle.

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Acetaminophen

Acetaminophen (Tylenol, Anacin-3, Panodal, Phenaphen, and Valadol) is a good alternative to NSAIDs, especially when stomach problems, ulcers, or allergic reactions prohibit their use. Products that combine acetaminophen with other drugs that reduce PMS symptoms are helpful. Brands include Pamprin, Midol, and Premsyn. Such drugs typically also include a diuretic to reduce fluid and an antihistamine. Little evidence exists to indicate whether they are more or less effective than NSAIDs or other mild pain relievers.

Antidepressants

Selective Serotonin-Reuptake Inhibitors. Selective serotonin-reuptake inhibitors (SSRIs) are drugs that keep higher levels of serotonin available in the brain. They have become the most effective treatments for premenstrual dysphoric disorder (PMDD) and for severe PMS symptoms. Three SSRIs are currently approved by the FDA for the treatment of PMDD symptoms. They are fluoxetine (Prozac, Sarafem), sertraline (Zoloft), and paroxetine (Paxil). Other SSRIs such as fluvoxamine (Luvox) and and citalopram (Celexa) are also being investigated for PMDD treatment.

Individuals taking SSRIs report not only relief from premenstrual dysphoric disorder but also physical symptoms, irritability, and tension. SSRIs appear to work much faster for relieving PMS-related depression than when used in major depression. These drugs are typically prescribed with either continuous (daily) dosing throughout the month or an intermittent dosing regimen. With intermittent dosing, women take the antidepressant during the 14-day premenstrual period of their luteal phase. This approach is also associated with fewer adverse effects than the standard regimens for major depression.

The following SSRIs are currently used or investigated for PMS and PMDD.

Sarafem was the first branded SSRI to be approved for premenstrual syndrome, including both physical and emotional symptoms. Approved in 2000, Sarafem contains the same ingredient (fluoxetine) as Prozac, but the agent is usually prescribed as intermittent therapy with daily dosing for the 14 days prior to the onset of menstruation. Studies show very positive effects on premenstrual dysphoric disorder, particularly at 20 mg. According to a 2003 study, once a woman stops this treatment, PMS symptoms may recur in the following cycle.
Sertraline (Zoloft) was approved in 2000 for treating PMDD as both a daily dose and intermittent therapy. A study published in 2004 suggested that both dosing regimens are equally effective. Sertraline also may have specific benefits, including improvement in sleep and memory and a lower risk for prolactin production. (Overproduction of this hormone has been associated with bone loss and absence of menstruation.)
Paroxetine (Paxil) was approved by the FDA in 2003 for the treatment of PMDD symptoms. As with fluoxetine and sertraline, it can be taken either on a continuous or intermittent basis.