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Premenstrual Syndrome (PMS) (cont.)

Medications

If you have moderate to severe premenstrual symptoms even after you've tried home treatment and lifestyle changes, talk to your doctor about using medicine. The most commonly used medicines for PMS are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.
  • Selective serotonin reuptake inhibitors (SSRIs) for mood-related symptoms.
  • Hormonal birth control, which may help relieve premenstrual dysphoric disorder (PMDD).
Click here to view a Decision Point.PMS: Should I Try an SSRI Medicine for My Symptoms?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • NSAIDs such as ibuprofen and naproxen relieve premenstrual pain and cramps and reduce menstrual bleeding. Try to start taking an NSAID 1 or 2 days before you expect pain to start. NSAIDs work best when taken before and at regular intervals throughout the premenstrual pain period.

Selective serotonin reuptake inhibitors (SSRIs)

Click here to view a Decision Point.PMS: Should I Try an SSRI Medicine for My Symptoms?

Hormonal birth control

  • A low-estrogen birth control pill such as YAZ or Yasmin may help relieve symptoms of severe PMS or PMDD.
  • Other types of birth control pills (estrogen-progestin) are widely prescribed for PMS. They may improve bloating, headache, belly pain, and breast tenderness in some women. But other women may have worse symptoms or develop mood problems.
  • Estrogen alone may offer some benefit for some women. But when estrogen is taken without progestin, it increases the risk of uterine (endometrial) cancer.
  • Progestin (progesterone) has been used in the past for PMS. But for some women, it may make physical and emotional symptoms worse.

For more information about birth control pills and progestin, see the topic Birth Control.

Diuretics

  • Spironolactone is a water pill (diuretic). It may reduce bloating and breast tenderness if taken during the premenstrual weeks.
  • Drospirenone, which is in the certain low-estrogen birth control pills, acts like a diuretic to relieve bloating and breast tenderness. This medicine may also help relieve symptoms of severe PMS or PMDD.

Less commonly used medicines

  • Propranolol, a beta-blocker medicine, may be used to treat migraines or headaches related to PMS.
  • Tricyclic antidepressants are not as well studied as SSRIs for PMS. They are generally less favored because of their possible side effects. But they do improve severe depression and insomnia for some women.
  • Alprazolam, an anti-anxiety medicine, is only recommended for a few days' use when other treatments have not worked. It can make you sleepy, loses effectiveness over time, and can be addictive. Long-term use may cause withdrawal or life-threatening symptoms.
  • Danazol, a synthetic male hormone, can relieve breast pain by decreasing estrogen production. It isn't often prescribed.
  • Gonadotropin-releasing hormone agonist (GnRH-a) is a last-resort treatment for severe PMDD. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.

Side effects

  • If you are taking medicine for PMS, talk with your doctor about birth control. Some medicines for PMS can cause birth defects if you take them while you are pregnant.
  • The side effects of some medicines may be just as unpleasant as your PMS symptoms. For example, GnRH-a and danazol have severe side effects. In other cases, the relief from symptoms that a medicine gives may far outweigh its side effects.
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