From the Research
Medications, specifically selective serotonin reuptake inhibitors (SSRIs), are recommended for the treatment of severe Premenstrual Syndrome (PMS) due to their effectiveness in reducing symptoms. The most recent and highest quality study, published in 2024 1, found that SSRIs probably reduce overall self-rated premenstrual symptoms in women with PMS and PMDD, with a moderate effect size.
Treatment Options
The following treatment options can be considered for severe PMS:
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, or paroxetine, which can be taken either continuously or only during the luteal phase
- Hormonal treatments like combined oral contraceptives, particularly those containing drospirenone
- NSAIDs like ibuprofen for pain and inflammation
- Spironolactone for bloating
- Lifestyle modifications, including regular exercise, stress management techniques, dietary changes, and ensuring adequate sleep
- Calcium and vitamin B6 supplements
Evidence
The 2024 study 1 included 34 randomized controlled trials and found that SSRIs were effective in reducing premenstrual symptoms, with a standardized mean difference of -0.57. The study also found that SSRIs were probably more effective when taken continuously compared to luteal phase administration. Another study published in 2020 2 found that adding fluoxetine to combined oral contraceptives containing drospirenone improved the management of severe PMS.
Adverse Effects
The 2024 study 1 found that SSRIs were associated with adverse effects, including nausea, insomnia, sexual dysfunction, fatigue, and dizziness. However, the overall certainty of the evidence was moderate, and the benefits of SSRIs in reducing premenstrual symptoms likely outweigh the risks for most women.
Recommendation
Based on the most recent and highest quality evidence, SSRIs are a recommended treatment option for severe PMS, and should be considered as a first-line treatment, along with lifestyle modifications and other therapies as needed.