Premenstrual Syndrome - Therapy

Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Acetaminophen

Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins, substances that dilate blood vessels and cause inflammation. NSAIDs are usually among the first drugs recommended for almost any kind of minor pain. The most common ones used for PMS are nonprescription ibuprofen (Advil, Motrin, Midol, generic) and naproxen (Aleve, generic) or prescription mefenamic acid (Postel, generic). Studies indicate that NSAIDs are most helpful when started 7 days before menstruation and continued for 4 days into the cycle.

Long-term daily use of any NSAID can increase the risk for gastrointestinal bleeding and ulcers. Long-term NSAID use can also increase the risk for heart attack and stroke.

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Acetaminophen (Tylenol) is a good alternative to NSAIDs, especially when stomach problems, ulcers, or allergic reactions prohibit their use. Products that combine acetaminophen with other drugs that reduce PMS symptoms may be helpful. Brands include Pamprin and Premsyn. Such drugs typically also include a diuretic to reduce fluid and an antihistamine. Little evidence exists to indicate whether they are more or less effective than NSAIDs or other mild pain relievers.

Antidepressants

Selective Serotonin-Reuptake Inhibitors. Selective serotonin-reuptake inhibitors (SSRIs) are drugs that keep higher levels of serotonin available in the brain. They have become the most effective treatments for premenstrual dysphoric disorder (PMDD) and for severe PMS mood symptoms.

In the United States, three SSRIs are approved by the FDA for the treatment of PMDD:

• Fluoxetine (Prozac, Sarafem, generic)
• Sertraline (Zoloft, generic)
• Paroxetine (Paxil, generic)

Other SSRIs sometimes prescribed for PMDD include citalopram (Celexa, generic) and escitalopram (Lexapro, generic). The serotonin-noradrenaline reuptake inhibitor venlafaxine (Effexor, generic) has also shown benefit in some studies.

SSRIs appear to work much faster for relieving PMS-related depression than when used in major depression. These drugs are typically prescribed with either continuous (daily) dosing throughout the month or an intermittent dosing regimen. With intermittent dosing, women take the antidepressant during the 14-day premenstrual period of their luteal phase.