Premenstrual Syndrome - Therapy

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[For more information, see In-Depth Report #91: Birth control options for women.]

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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. GnRH analogs appear to have little effect on depression.

GnRH agonists include nafarelin (Synarel), goserelin (Zoladex), leuprolide (Lupron), and buserelin (Suprefact).

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Common side effects (which can be severe in some women) include menopausal-like symptoms such as hot flashes, night sweat, weight change, and depression. The side effects vary in intensity, depending on the particular GnRH agonist. The most important concern is possible osteoporosis from estrogen loss. Doctors recommend that women not take these drugs for more than 6 months.

The most important concern is possible osteoporosis from estrogen loss. Doctors recommend that women not take these drugs for more than 6 months.

Click the icon to see an image of osteoporosis.

Danazol. Danazol (Danocrine) is a synthetic substance that resembles male hormones. It has very severe side effects and is used only if other therapies fail. It suppresses estrogen and menstruation and is used in low doses for severe PMS and premenstrual migraines. Side effects include masculinizing effects such as facial hair growth, deepening of the voice, and acne.

Diuretics for Fluid Retention

Diuretics are drugs that increase urination and help eliminate water and salt from the body. They reduce bloating and breast tenderness in women with PMS. Diuretics can have considerable side effects and should not be used for mild or moderate PMS symptoms. Spironolactone (Aldactone, generic) is the most commonly prescribed diuretic for PMS.

Spironolactone can increase potassium levels in the body. Women should be sure not to take additional potassium if they are taking spironolactone, and patients with kidney disease should avoid this medication. Diuretics interact with a number of other drugs, including certain antidepressants. Women who are considering diuretics should let their doctors know of any other drugs or supplements that they are taking.

Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).