From the Guidelines
Premenstrual Syndrome (PMS) treatment typically involves a combination of lifestyle modifications and pharmacological interventions.
Pharmacological Interventions
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (20mg daily) or sertraline (50mg daily) are commonly prescribed for symptom management, with treatment initiated 14 days prior to the anticipated onset of menses and continued through the first day of bleeding 1.
- Hormonal contraceptives like drospirenone (3mg) and ethinyl estradiol (30mcg) may be prescribed to regulate menstrual cycles and alleviate symptoms, although their use should be considered with caution in certain cases, such as in patients with hypogonadism or impaired bone health 1.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400mg every 4-6 hours) or naproxen (250mg every 8 hours) may also be used to manage pain and inflammation.
Considerations
- Non-pharmacological treatment strategies should be prioritized, particularly focusing on achieving resumption of menses, given the importance of menses and normal oestrogen status to bone health 1.
- Patients with symptoms of oestrogen deficiency, infertility, or impaired bone health may require pharmacological treatment, and hormonal agents should be considered as monotherapy in females with mild-to-moderate symptoms or as adjunctive agents for more severe disease 1.
From the Research
Treatments for Premenstrual Syndrome (PMS)
- Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMS and premenstrual dysphoric disorder (PMDD) 2, 3, 4, 5, 6
- SSRIs can be taken either in the luteal phase or continuously, with moderate-certainty evidence suggesting that continuous administration is more effective than luteal phase administration 6
- Other treatment options include:
- Anxiolytics
- Spironolactone
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for supportive care to relieve symptoms 2
- Hormonal therapies to suppress ovulation, although adverse effects may limit their use 2, 4
- Lifestyle modifications and exercise, which may be sufficient to treat mild-to-moderate symptoms 2
- Calcium supplementation, which has demonstrated a consistent therapeutic benefit 4
- Herbal and vitamin supplementation, as well as complementary and alternative medicine, have produced unclear or conflicting results and require further research 2, 4
Adverse Effects of SSRIs
- Common adverse effects associated with SSRIs include:
- Adverse effects are dose-dependent and may be more frequent with higher doses of SSRIs 5
Comparison of Treatment Options
- SSRIs are generally considered to be effective for reducing premenstrual symptoms, with a moderate effect size 5, 6
- The effectiveness of SSRIs may vary depending on the specific type of symptom being treated, with some studies suggesting that SSRIs are more effective for psychological symptoms than for physical symptoms 5