Should I Be Taking Something?
Whether you're a candidate for medication depends on the severity of your symptoms, your tolerance for certain drugs (and their potential side effects), and your preferences. The side effects of some medications may leave you feeling worse than plain PMS, but if your PMS significantly disrupts your life, medication may be the best answer.
Most physicians will suggest you alter your lifestyle before they prescribe drugs. This is the point at which you should cut back on caffeine, alcohol, sodium, and sugar and increase exercise. In addition, if you are open to complementary medicine, such as chiropractic, acupuncture, yoga or herbal supplements, you may find these approaches provide ample relief. However, proceed with caution if you decide pursue complementary or alternative medicine, as some commonly advocated forms of alternative therapy for PMS, such as evening primrose oil and progesterone creams, have been shown to provide no more relief than placebos.
Drug Treatments
Medications for PMS range from over-the-counter anti-inflammatory drugs and diuretics to birth control pills, hormone treatments, antidepressants, and antianxiety drugs. Which ones you take depends on which PMS symptoms are most severe.
Remember, before you consider taking any medication, ask your doctor the following questions:
How effective is this medication?
What are the potential side effects?
How will this drug interact with the medications and supplements I’m currently taking?
How long before I feel the effects?
When do the side effects develop? How can I tell?
Are there any things I should avoid while taking this drug?
Nonsteroidal anti-inflammatory drugs include over-the-counter versions such as aspirin and ibuprofen, as well as prescription versions. These drugs reduce inflammation by reducing prostaglandins (implicated in PMS) and are used to alleviate breast pain, headache, and menstrual cramps. However, prostaglandins also affect the stomach, so side effects include indigestion and heartburn, which means these drugs are not recommended for people with ulcers. (Some prescription versions have components that reduce the risk of ulceration.)
Diuretics, sometimes known as “water pills,” force the eliminate fluid through urination and are used for bloating, and PMS-related weight gain. (They are also used to treat high pressure, congestive heart failure, and glaucoma.) Diuretics are both in over-the-counter versions, such as Pamprin and Midol, well as in prescription form (such as spironolactone and metolazone).
Fact
Caffeine, alcohol, and cranberry juice are weak diuretics. Vitamin is a natural diuretic.
Most oral contraceptives contain two hormone compounds, estrogen and progestin, and reduce many PMS symptoms, except some mood symptoms. One brand of pill in particular, Yasmin, contains estrogen and drospirenone, has been shown to have PMS-reducing effects, including reducing bloating and changes. Another oral contraceptive containing only progestin prescribed for women who suffer severe headaches or high pressure, and for women who are breastfeeding. Progestin-only do not block ovulation and must be taken at the same time each day.
Alert
A 2002 analysis did not find any benefit from progestin-only contraceptives for women with PMS, however a 2002 British study found that progestin-only contraceptives were the most commonly prescribed for PMS symptoms. Check with your doctor to make sure you're taking the right formulation.
Hormone Treatments
Hormones such as nafarelin (Synarel), leuprolide (Lupron), and danazol (Danocrine) are used to stop ovulation (and your periods) by blocking GnRH (gonadotropin-releasing hormone), the hormone that stimulates the ovaries and starts the menstrual cycle, because when you don’t ovulate, you can’t get PMS. Up to half the women who receive hormone treatment get relief for their PMS symptoms. However, hormone treatments have their drawbacks. For one, they cause an artificial menopause, which has its own complications, such osteoporosis. In addition, danazol may increase certain fat levels the blood, so its not recommended for women with high cholesterol.
Progesterone therapy is quite popular in alternative medicine and even among some physicians, but studies have shown it provides no relief for PMS symptoms. The treatment is also not approved by the Food and Drug Administration. However, it is still prescribed by some doctors. Many alternative practitioners also promote progesterone creams or lotions.
These are usually the drug of choice for PMS-related depression, irritability, and anxiety; up to 60 percent of women experience relief while taking them. Side effects include drowsiness, nausea, and Women who decide to stop taking SSRIs must reduce their dosages very gradually to avoid side effects. (Chapter 18 has more information on SSRIs.)
Antidepressants such as fluoxetine hydrochloride (Sarafem or Prozac), sertraline (Zoloft), and paroxetine (Paxil) work by increasing serotonin activity in the brain. But they can cause serious side effects, such as nervousness, weight loss, uncontrollable hand shaking, joint pain, and even hallucinations. This class of drugs is usually prescribed for premenstrual dysphoric disorder (PMDD) and major depression, rather than PMS. Sarafem, the first drug marketed and approved as a PMDD treatment, is usually daily for fourteen days before menstruation. However, a 2003 showed that as soon as a woman stops taking this medication, returned the following month.
Antianxiety drugs
Antianxiety drugs like xanax are sometimes prescribed for women who don't get relief from their symptoms with SSRIs or other treatments. Antianxiety drugs work by depressing the central nervous system. Standard anti-anxiety drugs include benzodiazepines, such as alprazolam (xanax) and buspirone (BuSpar). Benzodiazepines are addictive and have significant side effects such as drowsiness and a hung-over feeling. Buspirone is milder: it is not addictive and has fewer side effects, and evidence suggests it reduces PMS-induced irritability.
