From the FDA Drug Label
Patients on oral contraceptives were excluded from these trials; therefore, the efficacy of sertraline in combination with oral contraceptives for the treatment of PMDD is unknown The effectiveness of sertraline for the treatment of PMDD was established in two double-blind, parallel group, placebo-controlled flexible dose trials (Studies 1 and 2) conducted over 3 menstrual cycles
SSRIs and Menstrual Cycles:
- The FDA drug label does provide information on the treatment of Premenstrual Dysphoric Disorder (PMDD) with sertraline, indicating its effectiveness in reducing symptoms of PMDD.
- However, it does not directly address whether SSRIs affect menstrual cycles in general, only that patients on oral contraceptives were excluded from the PMDD trials.
- Key Points:
From the Research
Yes, Selective Serotonin Reuptake Inhibitors (SSRIs) can affect menstrual cycles in some women. The most recent and highest quality study, 2, published in 2025, found that fluoxetine, a common SSRI, can cause menstrual irregularities, including delayed or missed periods, and changes in cycle length. These effects are thought to occur because serotonin plays a role in regulating hormones that control the menstrual cycle, particularly through its influence on the hypothalamic-pituitary-gonadal axis. When SSRIs increase serotonin levels in the brain, they can indirectly affect the release of reproductive hormones like estrogen and progesterone. Not all women experience these changes, and the severity varies from person to person. Some key points to consider:
- The incidence of antidepressant-induced menstruation disorder was 14.5% in one study 3.
- The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline, and their combination with mirtazapine 3.
- SSRIs can cause a range of menstrual irregularities, including delayed periods, missed periods, heavier or lighter bleeding, and changes in cycle length 2, 4. If you notice significant menstrual changes after starting an SSRI, it's essential to discuss them with your healthcare provider. They may recommend monitoring your cycles, adjusting your medication dosage, or switching to a different antidepressant if the menstrual changes are problematic. These effects are typically reversible once the medication is discontinued or adjusted. It's also worth noting that SSRIs can be effective in reducing premenstrual symptoms in women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) 4.