What Medicines Can Help?

There are a number of prescription medicines used to treat PMS, including:

• Birth control pills. These may help relieve the physical symptoms of PMS in some women, but the results are variable. Because birth control pills contain high levels of an estrogen-like hormone and progesterone -like hormone, they actually may cause premenstrual symptoms in some women. Women who experience PMS while on the pill should consider using another method of birth control.

• Progesterone. Many studies have been done using progesterone treatment for PMS. The majority of these studies have concluded that progesterone does not improve PMS symptoms.

• Selective serotonin-reuptake inhibitors (SSRIs). This class of antidepressants affects the availability of the neurotransmitter serotonin. The SSRIs fluoxetine (Prozac) and sertraline (Zoloft) have been shown in scientific studies to help reduce depression, irritability, and anxiety in PMS. Physical symptoms are usually helped too.

  Other SSRIs are also being studied for their effects on PMS. SSRIs can cause the side effects of drowsiness, nausea, and jitteriness in a small percentage of women. Women who begin SSRI therapy must decrease dosages very slowly to avoid possible side effects should they decide to stop the therapy. About 60 percent of women with severe PMS experience significant relief from SSRIs. Many take them throughout their menstrual cycle, but some have success using them just during the premenstrual phase.

• Anti-anxiety medicines. If SSRIs are not helpful, anti-anxiety medicines can be used to relieve anxiety associated with PMS. The one most commonly used is alprazolam (Xanax). It is in the class of medicines called benzodiazepines and works on the neurotransmitter GABA. Because alprazolam can be addictive it must be used cautiously. It should only be used during the few days a month when symptoms are worst. Alprazolam may cause drowsiness and difficulty operating motor vehicles.

  Another anti-anxiety medicine, buspirone (BuSpar), may also help reduce anxiety and depression in PMS. It is not addictive and has less severe side effects than the benzodiazepines.

• GnRH Agonists. Gonadotropin-releasing hormones (GnRH) agonists suppress the hormones that cause ovulation, causing a temporary menopause -like state. They are highly effective in treating PMS, including breast tenderness, irritability, and fatigue.

  However, GnRH agonists can also cause menopausal symptoms, such as hot flashes and vaginal dryness. In addition, long-term use (more than six months) is associated with bone loss (osteoporosis). Small doses of estrogen and progesterone can be given in addition to GnRH agonists to lessen these side effects and allow long-term use.