From the Research
Premenstrual syndrome (PMS) should be treated with selective serotonin reuptake inhibitors (SSRIs) as the first-line therapy, as they have been shown to be effective in reducing symptoms, with continuous administration being more effective than luteal phase administration 1. The diagnosis of PMS is based on the presence of physical and emotional symptoms that occur in the days or weeks before menstruation.
Treatment Options
- Lifestyle modifications, such as regular exercise, stress reduction techniques, and dietary changes, can help alleviate mild symptoms.
- Over-the-counter pain relievers, such as ibuprofen (200-400mg every 4-6 hours) or naproxen (220mg every 8-12 hours), can manage physical discomfort.
- For more severe symptoms, hormonal birth control pills may be prescribed to regulate hormonal fluctuations.
- SSRIs, such as fluoxetine (20mg daily) or sertraline (50-100mg daily), can effectively treat emotional symptoms, either taken daily or just during the luteal phase (two weeks 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 some benefit.
Rationale
PMS occurs due to normal hormonal changes affecting neurotransmitters like serotonin, which influences mood regulation. Tracking symptoms for 2-3 months can help identify patterns and determine the most effective treatment approach. If symptoms significantly impact daily life, consulting a healthcare provider is recommended for personalized treatment. The most recent and highest-quality study 1 supports the use of SSRIs as the first-line treatment for PMS, with continuous administration being more effective than luteal phase administration. This study provides moderate-certainty evidence for the effectiveness of SSRIs in reducing premenstrual symptoms, with a standardized mean difference of -0.57 (95% CI -0.72 to -0.42). The study also found that SSRIs are probably more effective when taken continuously compared to luteal phase administration, with a P-value of 0.03 for subgroup difference. Therefore, SSRIs should be considered as the primary treatment option for PMS, with continuous administration being the preferred method 1.