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The Treatment Of PMS/PMDD

For general PMS (premenstrual syndrome) relief, your doctor may recommend several non-medical strategies to reduce your symptoms.  If these do not provide sufficient relief, your doctor may recommend birth control pills or switching to another pill if you already take one.  Other prescription medical interventions will depend upon the types of symptoms which most affect you.  For example, if you are affected by bloating and weight gain, then your doctor may prescribe a certain type of diuretic (sprionolactone) to help your body eliminate the excess water. If severe breast tenderness is a major complaint, birth control pills are often recommended.  If this is insufficient, your doctor may prescribe a medication called bromocriptine to lower your levels of prolactin (a hormone linked to breast tenderness) or an androgen called Danazol®.   For dysmenorrhea, prescription prostaglandin inhibitors such as Naprosyn® or Ponstel® can be very effective if over-the-counter non-steroidal anti-inflammatory drugs such as Motrin® or Advil® were not sufficient.

If you have been diagnosed with PMDD (premenstrual dysphoric dysfunction) or severe PMS symptoms that interfere with your responsibilities or relationships, or if you tell your physician that you just feel out of control on those days, s/he may suggest that you try one of several prescription medication for PMDD.  The choices are diverse and represent two major classes of anti-depressant medications:  the selective serotonin reuptake inhibitors (SSRI's) and the tricyclic antidepressants. The SSRI's include medicines such as Paxil CR®, Prozac®, Effexor®, or Zoloft®.  They are generally well tolerated, work quickly, and reduce or eliminate disturbing emotional symptoms for many women often at doses significantly lower than those required to treat depression.  A recent study showed that this type of antidepressant medication worked significantly better for the treatment of PMS than the tricyclics, although tricyclics (e.g. Pamelor®, Elavil®) have a role in treating women with severe insomnia or those with combined depression and PMS.

There are many advocates for "natural" progesterone therapy for PMS.  However, to date, multiple controlled clinical trials of progesterone in several dosage forms has failed to show any benefit for the treatment of physical or emotional symptoms of PMS. 

In addition to conventional therapies, many women with PMS report that they have been helped by modalities such as biofeedback, relaxation techniques, acupuncture, and massage.  My general approach to these types of therapies is that if you find something that works for you, that's great.  For many patients, simple stress-reduction techniques such as taking long, hot baths or meditation are also helpful.

For more information about depression or other mental health issues, click here.

Created: 10/7/2003  -  Donnica Moore, M.D.

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