What Medications Treat Premenstrual Syndrome (PMS)?
Treatments demonstrated to be effective in PMS include medications that moderate the effects of the neurotransmitter serotonin. The selective serotonin reuptake inhibitor (SSRI) drugs such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) have been shown to be effective in relieving many of the symptoms of PMS and PMDD including mood changes and anxiety. Clinical trials show that SSRIs effectively treat mood symptoms such as depression, anxiety, and anger. Other symptoms of PMS, such as tiredness and decreased sexual drive, may not improve or may worsen on these drugs.
Anti-inflammatory medications such as ibuprofen 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. Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended initially, and there are several that may be purchased without a prescription.
Common nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat PMS include:
Hormones: Hormones such as nafarelin (Synarel) and leuprolide (Lupron) prevent the release of eggs and menstruation. 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. Women taking birth control pills with an inert week 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. It was not effective in treating other symptoms. Danazol may increase certain fat levels in the blood, so it is not recommended if the patient has high cholesterol levels. Because of the profound adverse side effect profile of Danazol, its use continues to decrease.
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 but may cause drowsiness. Benzodiazepines can be addictive. Diuretics (water pills) are drugs that help the body to shed excess water through the kidneys. These medicines have been used to reduce weight gain, breast swelling, and bloating associated with PMS. Metolazone (Mykrox, Zaroxolyn) and spironolactone (Aldactone) are commonly used diuretics. Research studies have not conclusively shown that diuretics are of benefit in managing PMS.
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 SSRIs, as described previously.