Section - Video Lectures

07. Medications for Symptomatic Relief in PMS and PMDD: Benzodiazepines, Buspirone, and NSAIDs

Published on November 1, 2020 Expired on April 1, 2024

Lauren Osborne, M.D.

Vice Chair of Clinical Research in the Department of Obstetrics and Gynecology - Weill Cornell Medicine

Key Points

SSRIs are a first-line treatment for PMDD/PMS.
For women who don't experience complete relief with SSRIs, consider adding symptomatic treatment for anxiety or irritability.
Alprazolam has the best evidence among the benzodiazepines.
Use anxiolytics in small doses, and taper off at the start of menses.
For significant physical symptoms, consider NSAIDs or bromocriptine.

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Slides and Transcript

Slide 1 of 7

So we've talked a lot about SSRIs as being the first-line treatment for PMDD. What about other kinds of medications? Are there medications for symptomatic relief that can also help in PMDD? Well, the reality is that only SSRIs have strong and convincing evidence for treatment of PMDD. But some women who have significant anxiety or irritability may benefit from symptomatic treatment of these specific symptoms as would be true for these symptoms when they present in other disorders.

Medications for Symptomatic Relief in PMS and PMDD: Benzodiazepines, Buspirone, and NSAIDs Slide 1 of 7

Slide 2 of 7

Such treatments can include anxiolytics such as buspirone or benzodiazepines. Buspirone, there was a placebo-controlled study of women with PMDD-like symptoms that found buspirone to be mildly effective for premenstrual irritability. It was a small sample size and the improvement in the irritability was not high. So there's not great evidence that that would be helpful. Among benzodiazepines, the best evidence exists for alprazolam which in several studies, in about four out of six controlled trials mostly with intermittent dosing, they've found alprazolam to be more effective than placebo for premenstrual anxiety and irritability, again as adjunctive treatment, not as the gold standard treatment that SSRIs represent.

References:

Landén, M., Eriksson, O., Sundblad, C., Andersch, B., Naessén, T., & Eriksson, E. (2001). Compounds with affinity for serotonergic receptors in the treatment of premenstrual dysphoria: a comparison of buspirone, nefazodone and placebo. Psychopharmacology, 155(3), 292-298.
Berger, C. P., & Presser, B. (1994). Alprazolam in the treatment of two subsamples of patients with late luteal phase dysphoric disorder: a double-blind, placebo-controlled crossover study. Obstetrics and gynecology, 84(3), 379-385.

Medications for Symptomatic Relief in PMS and PMDD: Benzodiazepines, Buspirone, and NSAIDs Slide 2 of 7

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08. Hormonal Treatments for Premenstrual Syndromes: Oral Contraceptives, GnRH Agonists, and Oophorectomy