ESCAPING THE PMS MAZE
by Geoffrey Redmond, MD
NSAIDs such as Motrin and Advil (ibuprofen), Alleve (Naproxen) can help cramps and overall bodily discomfort. When these do not work, there are related prescription medications which last longer and are give more complete relief. Some of these can also make periods lighter.
Diuretics (“water pills”) These get rid of excess fluid but your body pays a price for this. By dehydrating you, diuretics set off a new cycle of fluid retention. Strong ones such as furosemide (Lasix) should be avoided. There are milder alternatives which can be considered for women who retain a lot of fluid.
Tranquilizers These can have a soothing effect but can be addicting so are not a good solution.
Antidepressants The newer antidepressants termed SSRIs (selective serotonin reuptake inhibitors) can make a major difference for some women with PMS. The term “antidepressant” is somewhat misleading because SSRIs can help symptoms of PMS such as low energy, irritability and difficulty concentrating. Many women with these symptoms feel better on SSRIs even though they were not unhappy. They can be taken for some or all of each cycle.
The decision whether or not to use SSRIs or other prescription treatments is an important one. They are a good choice for some women but certainly are not necessary for all. Usually, herbs and supplements should be tried first but if PMS has reached a crisis point, SSRIs may offer the quickest relief. On the other hand, if you have a day or two of discomfort but are not slowed down by it, then supplements and other alternative approaches will probably be sufficient.
Trying an antidepressant does not commit you to a life on it. You can reassess once you are feeling yourself again.
Hormones Progesterone was once a common treatment for PMS but using it is complicated because of the need to time dosing with the menstrual cycle. But progesterone is worth a try if simpler measures do not work. It is best to have guidance from a physician experienced in adjusting progesterone to individual women’s cycles. Only a natural form should be used because some of the synthetics can make mood worse.
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