Several members of the selective serotonin reuptake inhibitor (SSRI) class of medications are effective in the treatment of PMDD. These medications work by regulating the levels of the neurotransmitter serotonin in the brain. SSRIs that have shown to be effective in the treatment of PMDD include:
- fluoxetine (Prozac, Sarafem),
- sertraline (Zoloft),
- paroxetine (Paxil), and
- citalopram (Celexa).
Up to 75% of women report relief of symptoms when treated with SSRI medications. Side effects can occur in up to 15% of women and include nausea, anxiety, and headache. SSRI medications to treat PMDD may be prescribed to be taken continuously or only during the 14-day luteal phase (second half) of the menstrual cycle. Other types of antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) and lithium (Lithobid) have not been shown to be effective in the treatment of PMDD.
Oral contraceptives and GnRH agonists
Medications that interfere with ovulation and the production of ovarian hormones have also been used to treat PMDD. Oral contraceptive pills (OCPs, birth control pills) can be prescribed to suppress ovulation and regulate the menstrual cycle.
Gonadotropin-releasing hormone analogs (GnRH analogs or GnRH agonists) have also been used to treat PMDD. These drugs suppress estrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injection forms of GnRH agonists are available.
Examples of GnRH agonists include:
- leuprolide (Lupron),
- nafarelin (Synarel), and
- goserelin (Zoladex).
The side effects of GnRH agonist drugs are a result of the lack of estrogen, and include hot flashes, vaginal dryness, irregular vaginal bleeding, mood changes, fatigue, and loss of bone density (osteoporosis). Adding back small amounts of estrogen and progesterone can help avoid or minimize many of the annoying side effects due to estrogen deficiency and help preserve bone density.
Danazol (Danocrine) is a synthetic drug that creates a high androgen (male type hormone) and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. It has been successfully used to treat PMDD, but up to 75% of women develop side effects from the drug including:
- weight gain,
- decreased breast size,
- oily skin,
- hirsutism (male pattern hair growth),
- deepening of the voice,
- hot flashes,
- changes in libido, and
- mood changes.
All of these changes are reversible, except for voice changes, but the return to normal may take many months. Because of these side effects, this medication is typically used only when other therapies have failed. Danazol (Danocrine) should not be taken by women with certain types of liver, kidney, and heart conditions.
Other treatments have also been shown in some studies to be beneficial in managing PMDD symptoms. Chasteberry extract (agnus castus fruit) was effective in decreasing the symptoms of PMS in a controlled trial. Several dietary supplements, including calcium, vitamin B6, and vitamin E, have also been shown in limited studies to reduce PMS/PMDD symptoms.