Premenstrual Syndrome (PMS): Medications

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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 newer kind of birth control pill, sold as YAZ and Yasmin, that helps with PMDD symptoms. YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms. These medicines are well proven and have a low risk of severe side effects.

Should I try an SSRI medicine for PMS symptoms?

Medication Choices

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

• Naproxen, ibuprofen, or mefenamic acid (such as Aleve, Motrin, Advil, or Ponstel). 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 (such as Prozac, Sarafem, Paxil, Zoloft, Luvox, or Celexa). These medicines improve the brain's use of the neurotransmitter serotonin, relieving depression, anxiety, irritability, aggression, and physical symptoms in many women with PMS and PMDD. They are effective either when taken during the premenstrual weeks only or when taken continuously.

Diuretic to treat water retention and weight gain

• Spironolactone (Aldactone). When taken during the premenstrual weeks, this diuretic reduces bloating and breast tenderness by blocking the body's use of the hormone aldosterone.¹⁰
• Drospirenone, in the birth control pill called Yasmin, acts like a water pill (diuretic). It relieves bloating and breast tenderness. In some women, it also relieves other emotional and physical PMS symptoms.⁹

Benzodiazepine to treat anxiety

• Alprazolam (such as Xanax) 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 one birth control pill with estrogen and drospirenone (sold as YAZ and Yasmin) that can help with moderate to severe PMS or PMDD. YAZ is very low-estrogen, and Yasmin is low-estrogen. The drospirenone improves severe physical and emotional symptoms in 1 in 8 women. It has a unique hormone action, and also acts like a water pill (diuretic).⁹ YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms.
• Other types of birth control pills (estrogen-progestin) are widely prescribed for PMS, but recent research has shown that birth control pills are not consistently effective for PMS. 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 are known to be ineffective for treating mood symptoms.¹ 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.¹⁰

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

Additional hormone treatments

• Danazol (Danocrine), a synthetic male hormone, can relieve breast pain by decreasing estrogen production. It isn't often prescribed because it can't be used long-term without causing weight gain, depression, deepening of the voice, smaller breasts, and cholesterol problems.
• Gonadotropin-releasing hormone agonist (GnRH-a) (such as Lupron Depot, Synarel, or Zoladex). A GnRH-a is a last-resort treatment for severe PMDD symptoms. Although a GnRH-a does control PMS by "shutting down" the ovaries, the tradeoff is that it is causes menopausal symptoms such as hot flashes and vaginal dryness.

Other antidepressants

• Tricyclic antidepressants (such as Elavil, Anafranil, or Tofranil) 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 medications

• Bromocriptine (Parlodel) can relieve breast pain by reducing prolactin production. But it isn't often prescribed because side effects are common, including nausea and vomiting, headache, cramps, and fatigue. A lowered dose can reduce side effects.
• Propranolol (Inderal) has been used to treat migraines or headaches related to PMS. Propranolol is a beta-blocker type of medicine that is most commonly used to treat heart-related conditions.

What To Think About

Using your menstrual 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. See an example of a menstrual diary (What is a PDF document?) .

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 effective has the medication been for other women?

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.

What are the medication's 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 will you have to take the medication?

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

Last updated:	June 19, 2008
Author:	Sandy Jocoy, RN
Reviewed By:	Kathleen Romito, MD - Family Medicine, Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC