From the Research
Selective serotonin reuptake inhibitors (SSRIs) are probably the most effective treatment for a 31-year-old woman with heavy menses and severe anxiety and panic attacks, as they have been shown to reduce overall self-rated premenstrual symptoms in women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) 1. For heavy menstrual bleeding, treatments like oral medroxyprogesterone acetate or a levonorgestrel intrauterine device can reduce bleeding by thinning the uterine lining. However, for anxiety symptoms, SSRIs are likely a better option, as they have been shown to be effective in reducing anxiety and panic attacks in women with PMS and PMDD 1, 2. Some key points to consider when prescribing SSRIs include:
- They are probably more effective when taken continuously compared to luteal phase administration 1
- They can increase the risk of adverse events, such as nausea, insomnia, and sexual dysfunction 1
- Lifestyle modifications like stress management techniques, regular exercise, and adequate sleep should complement any hormonal treatment
- Progesterone therapy may have calming effects on the nervous system through its metabolites, which enhance GABA activity in the brain, potentially reducing anxiety, but its effects are more complex and individual 2. It's essential to start with a thorough evaluation to rule out underlying conditions like thyroid disorders or structural uterine abnormalities and to monitor for side effects, including mood changes, breast tenderness, and headaches. Given the complexity of the condition and the potential for varying responses to treatment, a healthcare provider should prescribe and monitor any treatment.