Troubling physical and emotional symptoms that occur between the time you ovulate and the first days of your menstrual period are called premenstrual symptoms. When premenstrual symptoms interfere with your relationships or responsibilities, they are called premenstrual syndrome (PMS). When premenstrual emotional symptoms or aggression are severe, they are called premenstrual dysphoric disorder (PMDD).

If you have moderate to severe premenstrual symptoms that continue despite home treatment and lifestyle changes, talk to your health professional about using medication. Most medications for PMS affect some part of the hormone-producing endocrine system with the goal of blocking or increasing a certain chemical process that may be causing symptoms. There is no known medication that can "cure" PMS.

The most commonly used medications for PMS are nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and selective serotonin reuptake inhibitors (SSRIs) for mood-related symptoms. There is also a newer kind of birth control pill, sold as YAZ and Yasmin, that helps with PMDD symptoms. YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms. These medications are well proven and have a low risk of severe side effects.

Should I try an SSRI medication for PMS symptoms?

Medication Choices

Pain relievers (nonsteroidal anti-inflammatory drugs [NSAIDs])

• Naproxen, ibuprofen, or mefenamic acid (such as Aleve, Motrin, Advil, or Ponstel). NSAIDs relieve premenstrual and menstrual pain and reduce menstrual bleeding. They reduce inflammation, which is from increased prostaglandin production during the premenstrual period. NSAIDs work best when taken before and continued at regular dosage intervals throughout the premenstrual pain period. For some women, this continues into the first days of menstrual bleeding, to relieve painful cramps. If you have regular cycles, start taking an NSAID 1 to 2 days before you expect pain to start.

NSAIDs greatly improve premenstrual and menstrual pain. But, NSAIDs do not relieve breast tenderness.¹ They also do not relieve emotional PMS symptoms.

Selective serotonin reuptake inhibitors (SSRIs) to treat mood-related and physical symptoms

• Fluoxetine, paroxetine, sertraline, fluvoxamine, or citalopram (such as Prozac, Sarafem, Paxil, Zoloft, Luvox, or Celexa). These medications improve the brain's use of the neurotransmitter serotonin, relieving depression, anxiety, irritability, aggression, and physical symptoms in many women with PMS and PMDD. They are effective either when taken during the premenstrual weeks only or when taken continuously.

Diuretic to treat water retention and weight gain

• Spironolactone (Aldactone). When taken during the premenstrual weeks, this diuretic reduces bloating and breast tenderness by blocking the body's use of the hormone aldosterone.¹
• Drospirenone, in the birth control pill called Yasmin, acts like a water pill (diuretic). It relieves bloating and breast tenderness. In some women, it also relieves other emotional and physical PMS symptoms.¹¹

Benzodiazepine to treat anxiety

• Alprazolam (such as Xanax) is only recommended for a few days' use when other treatments have been ineffective. It depresses the central nervous system, loses effectiveness over time, and can be addictive. Long-term use can be complicated by withdrawal or life-threatening symptoms.

Hormonal treatments

• There is one birth control pill with estrogen and drospirenone (sold as YAZ and Yasmin) that can help with moderate to severe PMS or PMDD. YAZ is very low-estrogen, and Yasmin is low-estrogen. The drospirenone improves severe physical and emotional symptoms in 1 in 8 women. It has a unique hormone action, and also acts like a water pill (diuretic).¹¹ YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms.
• Other types of birth control pills (estrogen-progestin) are widely prescribed for PMS, but experts in the field no longer recommend these as a first-choice treatment.^{1, 10} Research has shown that birth control pills are ineffective or problematic for many women with PMS. Although they may improve bloating, headache, abdominal pain, and breast tenderness for some women, other women report that they have worse symptoms or they develop mood problems. Birth control pills are known to be ineffective for treating mood symptoms.⁴Estrogen alone may offer some benefit for some women, but when taken without progestin, it increases the risk of uterine (endometrial) cancer.
• Progestin (progesterone) has been used in the past for PMS but is now proven to be ineffective or to actually make physical and emotional symptoms worse.¹