From the Guidelines
Progesterone is a viable treatment option for a 31-year-old woman with heavy menses and severe anxiety and panic attacks who cannot tolerate SSRIs, as it can help manage both conditions simultaneously. For heavy menses, oral progesterone (such as medroxyprogesterone acetate 5-10mg daily for 10-14 days per month or norethindrone acetate 5-10mg daily) can reduce bleeding by stabilizing the endometrial lining. Although the study by 1 focuses on the use of SSRIs in children and adolescents with anxiety disorders, it does not provide direct evidence for the use of progesterone in adults with anxiety. However, progesterone's neuroprotective and anxiolytic effects have been documented in other studies, suggesting its potential benefits for anxiety symptoms. Some key points to consider when using progesterone for this patient include:
- Starting treatment during the luteal phase (typically days 14-28) of the menstrual cycle
- Using natural progesterone (100-200mg orally at bedtime) for its calming effects on the nervous system
- Monitoring for potential side effects, such as breast tenderness, bloating, or mood changes
- Evaluating the patient before starting treatment to rule out underlying conditions and determine the most appropriate formulation and dosage. It is essential to consult a gynecologist or primary care provider to determine the best course of treatment for this patient.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Progesterone as an Alternative to SSRIs
- There is no direct evidence to suggest that progesterone can help a 31-year-old woman with heavy menses and severe anxiety and panic attacks who cannot tolerate SSRIs 2, 3, 4, 5, 6.
- However, it is known that SSRIs are commonly used to treat anxiety disorders, including panic attacks, and have been shown to be effective in reducing symptoms 2, 3, 5.
- The use of SSRIs in women with heavy menses may be complicated by the potential for adverse effects, such as nausea, insomnia, and sexual dysfunction 2, 4.
- Progesterone has been used to treat various gynecological conditions, including heavy menses, but its effectiveness in treating anxiety and panic attacks is not well established 6.
Alternative Treatments for Anxiety and Panic Attacks
- Serotonin norepinephrine reuptake inhibitors (SNRIs) may be an alternative treatment option for anxiety disorders, including panic attacks, and have been shown to be effective in reducing symptoms 3, 5.
- Other treatment options, such as cognitive-behavioral therapy and lifestyle modifications, may also be effective in managing anxiety and panic attacks.