From the Guidelines
For severe PMS, OCPs, particularly those containing drospirenone, are a reasonable treatment option, as they can effectively suppress ovulation and stabilize hormone fluctuations that trigger symptoms, with a recent study from 2023 1 showing promise in mitigating adverse effects on blood pressure. When considering treatment options for severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), both oral contraceptive pills (OCPs) and Lexapro (escitalopram) are viable choices. Key factors to consider when deciding between these options include:
- Symptom profile
- Contraceptive needs
- Medical history
- Potential side effects OCPs, especially those with drospirenone like Yaz or Yasmin, are effective by suppressing ovulation and stabilizing hormone fluctuations, typically taken daily with 24 active pills and 4 placebo pills per cycle. Alternatively, Lexapro, a selective serotonin reuptake inhibitor (SSRI), can be prescribed at 10-20mg daily, either continuously or just during the luteal phase, working by increasing serotonin levels in the brain to regulate mood. Recent evidence from 2023 1 highlights the potential benefits of newer OCP formulations, including those with natural estrogens like estradiol valerate and estetrol, which may have fewer adverse effects on blood pressure compared to synthetic estrogens. However, the choice between OCPs and Lexapro should be individualized, taking into account the patient's specific needs and medical history, with consultation from a healthcare provider to explore other options or adjust dosing if first-line treatments are ineffective. It's also important to consider lifestyle modifications like regular exercise, stress management, and dietary changes to complement medical treatment. Ultimately, the decision between OCPs and Lexapro for severe PMS should prioritize the patient's overall health, well-being, and quality of life, with careful consideration of the potential benefits and risks of each treatment option, as supported by recent studies 1.
From the FDA Drug Label
Drospirenone and ethinyl estradiol tablets have not been shown to be effective for the treatment of premenstrual syndrome (PMS), a less serious set of symptoms occurring before menstruation. If you or your healthcare provider believe you have PMS, you should take drospirenone and ethinyl estradiol tablets only if you want to prevent pregnancy; and not for the treatment of PMS
For severe PMS, OCPS (oral contraceptive pills) like drospirenone and ethinyl estradiol tablets are not recommended as a treatment for PMS symptoms, but may be considered for birth control. Lexapro is not mentioned in the provided drug label, therefore no conclusion can be drawn about its use for severe PMS based on this information 2.
From the Research
Treatment Options for Severe PMS
- Oral contraceptive pills (OCPs) and selective serotonin reuptake inhibitors (SSRIs) like Lexapro are considered for treating severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) 3, 4, 5, 6.
Efficacy of OCPs
- OCPs containing drospirenone and a low estrogen dose may help treat premenstrual symptoms in women with severe symptoms, such as PMDD 3, 4, 7.
- These OCPs have been shown to improve overall premenstrual symptoms, functional impairment, and response rate to study medications 4.
Efficacy of SSRIs
- SSRIs, including Lexapro, are highly effective in treating premenstrual symptoms, including physical, functional, and behavioral symptoms 5, 6.
- They can be taken either in the luteal phase or continuously, with no clear evidence of a difference in effectiveness between these modes of administration 6.
Adverse Effects
- OCPs containing drospirenone may lead to more adverse effects, such as nausea, intermenstrual bleeding, and breast pain, compared to placebo 3, 4.
- SSRIs may cause adverse effects, such as nausea, asthenia, somnolence, fatigue, decreased libido, and sweating, with the most common being nausea and asthenia 6.