Medications for Premenstrual Syndrome (PMS)

***Please note FDA Public Health Advisory for Antidepressants:

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose. Although the warning is for all antidepressants, of most concern are the SSRI class such as:

• Prozac ( fluoxetine]]> ), Zoloft ( ]]>sertraline]]> ), Paxil ( ]]>paroxetine]]> ), Luvox ( ]]>fluvoxamine]]> ), Celexa ( ]]>citalopram]]> ), Lexapro( ]]>escitalopram]]> )

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** see note]]> above

Common names include:

• ]]>Citalopram]]> (Celexa)
• ]]>Fluvoxamine]]> (Luvox)
• ]]>Paroxetine]]> (Paxil)
• ]]>Fluoxetine]]> (Prozac, Sarafem)
• ]]>Sertraline]]> (Zoloft)

Serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin in the brain. These medications are used in the treatment of ]]>premenstrual dysphoric disorder]]> (PMDD), a rarer and much more severe form of PMS. The medication can help relieve ]]>depression]]>, irritability, and some of the physical symptoms. SSRIs may also offer benefit to women who have severe PMS, but are not diagnosed with PMDD.]]>*¹]]>

SSRIs tend to work much faster in relieving depressive symptoms associated with PMS than they do when faced with major depression. Depending on your condition, you may only need to take SSRIs during the two-week premenstrual period.

Possible side effects include:

• Nausea
• ]]>Diarrhea]]>
• ]]>Insomnia]]>
• Sexual dysfunction

Benzodiazepines

Common names include:

• Alprazolam]]> (Xanax)
• ]]>Lorazepam]]> (Ativan)

Benzodiazepines may be helpful if you have severe premenstrual anxiety that is not relieved by SSRIs or other treatments. These drugs must be used judiciously because they can cause dependency if used on a regular basis for three months or more. It may be best to use these drugs only a few days a month when symptoms are most severe.

Possible side effects include:

• Drowsiness
• Dizziness

Oral Contraceptives

Hormonal contraceptives suppress ovulation and perhaps thereby, can provide relief of PMS in many women. Depending on your medical history and risk factors, your healthcare provider may prescribe combined oral contraceptive pills (which contain both estrogen and progestin) or a progestin-only contraceptive.

Possible side effects include:

• Mood changes
• Breast tenderness
• Headaches
• Unpredictable spotting (usually resolves after first 3 cycles)

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective for pain relief during PMS by blocking prostaglandins, which are substances that cause inflammation. NSAIDs should be used on a short-term basis and in the lowest effective dosages. With the exception of the COX-2s, many are available in both prescription and a lower dose, nonprescription form ( ie, over-the-counter strength). They should be taken with food to minimize stomach irritation and upset.

*** see note]]> above

Prescription strength includes:

• COX-2 inhibitors: Valdecoxib (Bextra), ]]>Celecoxib]]> (Celebrex)
• Prescription strength general NSAIDS: ]]>Ibuprofen]]> (Motrin), ]]>Naproxen]]> (Anaprox, Naprelan, Naprosyn)

Common non-prescription or over-the-counter names include:

• Ibuprofen (Motrin, Advil, Nuprin, Rufen)
• Naproxen (Aleve)

Possible side effects** include:

• Stomach pain, cramps, or discomfort
• Heartburn
• Indigestion
• Nausea and vomiting

**Note: These side effects are much less common with the COX-2s, which were specifically developed not to affect stomach enzymes.

Acetaminophen]]>

Common brand names include:

• Tylenol
• Anacin-3
• Panodal
• Phenaphen
• Valadol

If you have stomach distress, ]]>ulcers]]> , or allergic reactions to NSAIDs, acetaminophen may be used as an alternative to help relieve pain during PMS.

Possible side effects** include:

• Stomach pain, cramps, or discomfort
• Heartburn
• Indigestion
• Nausea and vomiting

**Note: These side effects are more common with NSAIDs than acetaminophen.