Premenstrual Syndrome - Medications

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[For more information, see In-Depth Report #28: Anxiety.]

Hormone Therapies

Birth Control Pills. Most oral contraceptives (OCs) combine progestins (either natural or synthetic forms of progesterone) and estrogen (usually ethinyl estradiol). Some doctors advise women with PMS to skip the 7-day placebo interval of their birth control medication and instead use the active drugs on a continuous basis to avoid monthly menstruation.

New OCs are also being developed to specifically treat the mood symptoms associated with premenstrual dysmorphic disorder (PMDD):

• Yaz is a new low-dose birth control pill approved in 2006. It combines the estrogen estradiol with a new type of progestin called drospirenone. In clinical trials, Yaz helped improve mood and relieve PMDD symptoms when used in a 24/4 dosing regimen (24 days active pills, 4 days placebo pills). The FDA is considering approving Yaz for treatment of PMDD.
• Lybrel is a low-dose combined contraceptive that contains estradiol and levonorgestrel. The FDA is currently reviewing Lybrel. If approved, Lybrel will be the first birth control pill taken on a continuous basis with no pill-free interval. Lybrel is designed to completely eliminate periods and, therefore, may also help eliminate PMS. In clinical trials, women who took Lybrel experienced relief of PMS symptoms within a month of starting the drug.

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Side effects of OCs include nausea, breakthrough bleeding, breast tenderness, headache, and weight gain. Women who smoke, or who are at risk for blood clots or stroke, should avoid oral contraceptives or use them with caution.

Click the icon to see an illustrated series detailing the birth control pill.

GnRH Agonists. Gonadotropin-releasing hormone (GnRH) agonists (also called analogs) are powerful hormonal drugs that suppress ovulation and, thereby, the hormonal fluctuations that produce PMS. They are sometimes used for very severe PMS symptoms and to improve breast tenderness, fatigue, and irritability. (These drugs, in fact, are sometimes used to rule out or confirm a diagnosis of PMS. If symptoms persist while the drug is being taken, then PMS is unlikely to be their cause.) GnRH analogs, however, appear to have little effect on depression.