Medications

Troubling physical and emotional symptoms that occur between the time you ovulate and the first days of your menstrual period are called premenstrual symptoms. When premenstrual symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS). When premenstrual emotional symptoms or aggression are severe, they are called premenstrual dysphoric disorder (PMDD).

If you have moderate to severe premenstrual symptoms that continue despite home treatment and lifestyle changes, talk to your health professional about using medicine. Most medicines for PMS affect some part of the hormone-producing endocrine system, with the goal of blocking or increasing a certain chemical process that may be causing symptoms. There is no known medicine that can "cure" PMS.

The most commonly used medicines for PMS are nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and selective serotonin reuptake inhibitors (SSRIs) for mood-related symptoms. There is also a type of birth control pill, sold as YAZ and Yasmin, that may help relieve PMDD symptoms.

PMS: Should I Try an SSRI Medicine for My Symptoms?

Pain relievers (nonsteroidal anti-inflammatory drugs [NSAIDs])

• Naproxen, ibuprofen, or mefenamic acid. NSAIDs relieve premenstrual and menstrual pain and reduce menstrual bleeding. They reduce inflammation, which is from increased prostaglandin production during the premenstrual period. NSAIDs work best when taken before and continued at regular dosage intervals throughout the premenstrual pain period. For some women, this continues into the first days of menstrual bleeding, to relieve painful cramps. If you have regular cycles, start taking an NSAID 1 to 2 days before you expect pain to start.

Selective serotonin reuptake inhibitors (SSRIs) to treat mood-related and physical symptoms

• Fluoxetine, paroxetine, sertraline, fluvoxamine, or citalopram. SSRIs can restore the balance of certain brain chemicals called neurotransmitters. This may help relieve physical and emotional symptoms of PMS. They are effective either when taken during the premenstrual weeks only or when taken continuously.

Diuretic to treat water retention and weight gain

• Spironolactone. When taken during the premenstrual weeks, this diuretic may reduce bloating and breast tenderness by blocking the body's use of the hormone aldosterone.
• Drospirenone, in the birth control pill called Yasmin or YAZ, acts like a water pill (diuretic). It relieves bloating and breast tenderness. This medicine may also help relieve symptoms of severe PMS or PMDD.

Benzodiazepine to treat anxiety

• Alprazolam is only recommended for a few days' use when other treatments have been ineffective. It depresses the central nervous system, loses effectiveness over time, and can be addictive. Long-term use can be complicated by withdrawal or life-threatening symptoms.

Hormonal treatments

• There is a birth control pill with estrogen and drospirenone (sold as YAZ and Yasmin) that may help relieve symptoms of severe PMS or PMDD. YAZ is very low-estrogen, and Yasmin is low-estrogen.
• Other types of birth control pills (estrogen-progestin) are widely prescribed for PMS, but birth control pills may not relieve PMS symptoms for everyone. Although they may improve bloating, headache, abdominal pain, and breast tenderness for some women, other women report that they have worse symptoms or they develop mood problems. Birth control pills do not appear to help relieve mood symptoms. Estrogen alone may offer some benefit for some women, but when 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.

Additional hormone treatments

• Danazol, a synthetic male hormone, can relieve breast pain by decreasing estrogen production. It isn't often prescribed.
• Gonadotropin-releasing hormone agonist (GnRH-a). A GnRH-a is a last-resort treatment for severe PMDD symptoms. This medicine stops the monthly menstrual hormonal cycle and results in a condition similar to menopause.

Other antidepressants

• Tricyclic antidepressants are not as well studied as SSRIs for PMS and are generally less favored because of their possible side effects. But they do improve severe depression and insomnia for some women.

Other medicines

• A beta-blocker medicine, propranolol, may be used to treat migraines or headaches related to PMS.

What to think about

Using your menstrual diary(What is a PDF document?) or symptom diary, show your health professional which symptoms are the most bothersome to you. He or she can then recommend treatment that focuses on relieving your worst symptoms.

If you are considering medication treatment, it may be helpful to think about and discuss some of the following questions with your health professional:

How well the medicines work

Some medicines and dietary supplements have been shown to be effective in relieving symptoms of PMS. Other medicines used to treat PMS have been shown to be no more effective than a "sugar pill" (placebo). Some of these medicines, such as progesterone, may be recommended. But it is better to use medicines, vitamins, or minerals that studies have shown to be effective. You may also want to think about the cost of a medicine that may or may not work.

Side effects

The side effects of some medicines may be just as unpleasant as your PMS symptoms. For example, gonadotropin-releasing hormone agonists (GnRH-a) and danazol have significant adverse side effects. In other cases, the relief from symptoms that a medicine gives may far outweigh any side effects it causes.

How often to take the medicines

Some medicines must be taken every day, but others may only be taken when your symptoms are present. If your symptoms aren't severe and don't last long, you may not think the benefits of medicine treatment are worth taking the medicine every day.