Medication Several medications have been shown to effectively reduce the physical and emotional symptoms of<unk> . Antidepressant Treatment Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication. Women taking SSRIs to ease<unk>  generally report >50% alleviation in symptoms, which was significant improvement compared to placebo. Two approaches to dosing have been studied: continuous dosing (daily) and luteal dosing (14 days before menstruation and discontinuing at the onset of menses). Both dosing schedules have similar effectiveness with some recent studies demonstrating greater symptom control with continuous dosing. This gives patients control of how they want to dose their medication in alliance with their mental health provider. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) have also been studied in the treatment of<unk>  and shown efficacy in reducing symptoms. These are an alternative for patients who do not respond to SSRI's. However, they are more likely to be dosed continuously due to SNRI discontinuation syndrome - a flu-like feeling caused by dropping blood levels of SNRI. Anxiolytics Two medications typically given to reduce acute anxiety have been studied in treatment for<unk> : alprazolam (Xanax) and buspirone. Alprazolam carries a risk of abuse and causes central nervous system depression and results of clinical trials have not shown benefit to treatment. Buspirone showed lower efficacy than SSRI, but may be used as an adjunctive treatment or alternative if SSRI side effects are intolerable to the patient. Psychotherapy Cognitive behavioral therapy (CBT) has been shown to be effective for reducing premenstrual symptoms in women with (retrospectively-reported) PMS. CBT is an evidence-based approach for treating depression and focuses on the link between mood, thoughts, and actions to help women address current issues and symptoms. When CBT was compared to SSRI alone or in combination with SSRI, groups receiving CBT had significant improvement of PMS symptoms. Through the practice of CBT, women are better able to recognize and modify recurrent issues as well as thought and behavior patterns that interfere with functioning well or that make depressive symptoms worse. However, a recent meta-analysis suggests that existing psychotherapies may be primarily useful for reducing impairment (rather than symptom severity) in<unk> . Hormonal Treatment Oral contraceptives have been effective in reducing PMS symptoms, but only certain formulations have proven to be modestly effective in the treatment of<unk> . transdermal estrogen and intrauterine devices containing levonorgestrel have also had modest efficacy. Another FDA approved treatment for<unk>  is the oral contraceptive with ethinylestradiol and drospirenone (a novel progestin) taken on a 24-4 schedule (24 active pills, 4 inactive pills). It has been shown that hormonal birth control containing drospirenone and low levels of estrogen helps relieve severe<unk>  symptoms, for at least the first three months that it is used. The idea behind using oral contraceptives is to suppress ovulation, therefore suppressing sex hormone fluctuations. Another treatment, typically used when other options have failed, is injection of a gonadotropin-releasing hormone(GnRH) agonist with adjunctive estrogen and progesterone or tibolone. This is a last resort because GnRH antagonists can cause medical menopause by shutting down the body's pathway for reproductive hormones called the hypothalamic, pituitary, gonadal axis. As a result, GnRH therapy presents increased risk of osteopenia (decreased bone density) and cardiovascular disease. This therapy is often reserved for patients considering surgical menopause to test the outcome of the surgery. Surgical Menopause In a minority of patient who meet specific criteria and drug-based treatments are ineffective or produce significant side effects, hysterectomy and bilateral oophorectomy followed by estrogen replacement therapy is an option Typically, the uterus is removed during the same surgery, and the women is prescribed a low-dose estrogen patch to reduce the symptoms produced by surgically induced menopause. There are five guidelines that should be considered before undergoing a surgical treatment. The vast majority of women with<unk>  will not require surgical treatment to experience resolution of symptoms. * The diagnosis of<unk>  must be confirmed * GnRH agonist therapy must be the only medical therapy that has been effective and it must have been effective continuously for a minimum of six months * Tolerance of estrogen replacement therapy has been tested * The woman is done with childbearing * The woman's age warrants several more years of therapy Adjunctive and Alternative Treatments Other proposed treatments include dietary modification, herbal remedies including St John's Wort and chasteberry, acupuncture, and exercise. Some evidence suggests caffeine, sugar and alcohol intake may increase PMS symptoms. A review article claimed significant improvement of PMS symptoms with herbal treatments and acupuncture but the studies selected for review did not stratify severity of symptoms. Finally, the American College of Obstetricians and Gynecologists recommends regular aerobic exercise to reduce PMS symptoms.
Premenstrual dysphoric disorder
Major depressive disorder
Premenstrual syndrome
Anxiety disorder
Menstrual disorder
Postpartum depression
Postpartum psychosis
Minor depressive disorder