From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Premenopausal syndrome treatment should prioritize selective serotonin reuptake inhibitors (SSRIs) and lifestyle modifications, as they have been shown to be effective in reducing symptoms, according to the most recent and highest quality study 1.
Treatment Options
The treatment of premenopausal syndrome (PMS) involves a combination of lifestyle modifications and medications.
- Lifestyle changes should be tried first, including:
- Regular exercise
- Stress reduction techniques
- Adequate sleep
- Dietary changes such as reducing caffeine, salt, and alcohol while increasing complex carbohydrates and calcium-rich foods
- Over-the-counter pain relievers like ibuprofen (200-400mg every 4-6 hours) or naproxen sodium (220mg every 8-12 hours) can help manage physical symptoms.
- For more severe symptoms, hormonal treatments such as combined oral contraceptives (like Yaz or Yasmin) can regulate hormonal fluctuations.
- SSRIs like fluoxetine (20mg daily), sertraline (50-150mg daily), or paroxetine (20mg daily) are effective for emotional symptoms and can be taken either continuously or just during the luteal phase (14 days before menstruation) 1.
- Diuretics like spironolactone (25-100mg daily) may help with bloating.
- Calcium (1200mg daily) and vitamin B6 (50-100mg daily) supplements have shown modest benefits 2.
- Cognitive behavioral therapy can also be beneficial for managing emotional symptoms.
Rationale
The most recent and highest quality study 1 supports the use of SSRIs in the management of severe PMS, with a significant reduction in overall symptomatology, physical, functional, and behavioral symptoms.
- The study found that SSRIs were highly effective in treating premenstrual symptoms, with a standardized mean difference of -0.53 (95% CI -0.68 to -0.39; P < 0.00001) 1.
- The evidence also suggests that lifestyle modifications, such as regular exercise and dietary changes, can help alleviate symptoms 2.
- Hormonal treatments, such as combined oral contraceptives, can regulate hormonal fluctuations and reduce symptoms 3.
Considerations
When treating premenopausal syndrome, it is essential to consider the individual patient's symptoms, medical history, and preferences.
- A thorough diagnosis and evaluation of symptoms are necessary to determine the best course of treatment.
- Patients should be educated on the available treatment options and involved in the decision-making process.
- Regular follow-up and monitoring of symptoms are crucial to adjust the treatment plan as needed.