Premenstrual Syndrome (PMS) (cont.)

Medications

PMS treatment

• Anti-inflammatories: These drugs prevent the body from producing prostaglandins, which have been suggested as a cause of PMS. Reducing the amount of prostaglandins in the body may eliminate many of the inflammatory symptoms of PMS such as menstrual cramps, breast pain, headache, swelling, and other discomforts. Several types of anti-inflammatory agents are used for PMS. Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended initially, and there are several that may be purchased without a prescription. COX-2 inhibitors are a new type of NSAID that must be obtained with a prescription. These are longer-acting than most NSAIDs and have less risk of causing stomach discomfort or ulcers.
• Alert: On September 30, 2004, Merck & Co, Inc, announced a voluntary withdrawal of the COX-2 inhibitor rofecoxib (Vioxx) from the US and worldwide market because of its association with an increased rate of cardiovascular events (including heart attacks and strokes) compared to that of placebo. A major US Food and Drug Administration (FDA) study of rofecoxib found an apparent 3-fold increase in the risk of sudden cardiac death or heart attack among patients who had taken higher doses of the drug compared to the risk of patients who had not recently received similar medication. The report showed that even patients taking the standard starting dose of 12.5 mg or 25 mg of rofecoxib had a 50% greater chance of heart attack or sudden cardiac death than patients on any dose of celecoxib (Celebrex). The large-scale study was conducted after analyzing the medical records of 1.4 million people insured by Kaiser Permanente in Oakland, Calif, between 1999-2001. Note: The study has inherent limitations in that it is observational, rather than randomized and controlled.
• Alert: On April 7, 2005, valdecoxib (Bextra, by Pfizer, Inc) was voluntarily withdrawn from the US market, pending further discussion with the FDA. The association of valdecoxib with potentially life-threatening risks, including myocardial infarction, stroke, and serious skin reactions, initiated an investigation to determine whether the benefits of the drug outweighed the risks. The serious skin reactions are most likely to occur in the first 2 weeks of treatment, but they can occur any time during therapy. Valdecoxib should be discontinued at the first sign of rash, mouth sores, and/or allergic reactions (eg, swelling, itching, shortness of breath). Other COX-2 inhibitors and traditional NSAIDs (eg, naproxen [Aleve, Naprosyn], ibuprofen [Motrin]) also have a risk for these rare, serious skin reactions, but the reported rate of the reaction appears to be greater for valdecoxib. New data regarding risks in individuals who take valdecoxib following heart bypass surgery showed an increased risk of heart attack, stroke, deep vein thrombosis (blood clots in the leg), and pulmonary embolism (blood clots in the lungs).
• NSAIDs
  • Diclofenac (Cataflam, Voltaren)
  • Ibuprofen (Motrin)
  • Ketoprofen (Orudis)
  • Meclofenamate (Meclomen)
  • Mefenamic acid (Ponstel)
  • Naproxen (Aleve, Naprosyn)
  
  
• COX-2 inhibitors: Celecoxib (Celebrex)
• Hormones: Hormones such as nafarelin (Synarel) and leuprolide (Lupron) prevent your body from releasing eggs and undergoing a menstrual cycle. Therefore, if you take these medications, you will not ovulate and will not menstruate. This treatment eliminates PMS symptoms in more than half of all women receiving it. These hormones are like birth control pills in that they suppress the menstrual cycle, but the cycle returns when they are stopped. However, women taking the birth control pill still bleed every month. Women on this therapy have no periods at all. However, most contraceptive pills and patches can be used in a continuous fashion to reduce or eliminate withdrawal bleeding. 
• Danazol (Danocrine) is another hormonal agent that blocks the production and the effects of certain female hormones. Danazol is a modified male sex hormone, which was shown to significantly decrease breast pain in clinical studies. However, it was not effective in treating other symptoms. Because danazol may increase certain fat levels in the blood, it is not recommended if you have high cholesterol levels. Because of the profound adverse side effect profile of danazol, its use continues to decrease.
• Anti-anxiety drugs: Benzodiazepines are drugs that decrease anxiety by depressing the central nervous system. Alprazolam (Xanax) is a member of this class. It can be effective in treating the anxiety associated with premenstrual syndrome. You may feel drowsy if you take this type of medicine. Benzodiazepines can be addictive.
• Antidepressants: Fluoxetine (Sarafem, also known as Prozac), sertraline (Zoloft), and paroxetine (Paxil) are medicines that help the body increase the activity of serotonin, a brain chemical that has been shown to be low in some women with PMS (and in those with PMDD). Clinical trials show that SSRIs effectively treat mood symptoms such as depression, anxiety, and anger. However, other symptoms of PMS, such as tiredness and decreased sexual drive, may not improve or may become worse on these drugs.
• Diuretics: Diuretics (commonly called water pills) are drugs that help the body to shed excess water through the kidneys. These medicines significantly help reduce the weight gain, breast swelling, and bloating associated with PMS. Metolazone (Mykrox, Zaroxolyn) and spironolactone (Aldactone) are 2 commonly used diuretics.
• Others: Other treatments that may work but not been evaluated in scientific trials include lithium, progesterone, and birth control pills. Case reports of progesterone organogel have shown promising results (especially in teenaged girls) in relieving mood symptoms.

PMDD treatment: The same lifestyle changes that sometimes help women with PMS may help relieve the symptoms of PMDD. In most cases, however, PMDD symptoms continue despite such efforts. Studies show that some women with PMDD benefit from treatment with antidepressants called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Sarafem, also known as Prozac), sertraline (Zoloft), and paroxetine (Paxil). The same medications are also commonly given to treat depression. If your doctor prescribes one of them for PMDD, you may be given a low dose and take it for just part of each month.

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