Can SSRI’s help women suffering with PMS?
Vanessa Jordan
1 *
1
Jespersen C, Lauritsen MP, Frokjaer VG, Schroll JB. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database of Systematic Reviews 2024, Issue 8. Art. No. CD001396. doi:10.1002/14651858.CD001396.pub4.1
Background
It is estimated that between 20 and 30% of women of reproductive age suffer from symptoms of premenstrual syndrome (PMS).2 The total number of women suffering from PMS and the number of years lived with disability due to PMS, have increased significantly over the past 30 years.2 Premenstrual dysphoric disorder (PMDD) is a severe form of PMS.3 It has been proposed that selective serotonin reuptake inhibitors (SSRIs) may help to manage PMS/PMDD by affecting gamma-aminobutyric acid (GABA) levels through neuroactive steroids. Specifically, SSRIs shift the way the hormone progesterone is converted into other substances and this may help calm the brain. This could potentially help improve mood and reduce symptoms associated with PMS/PMDD.4
Clinical bottom line
This Cochrane review suggests that SSRIs are likely effective in reducing PMS and PMDD symptoms, whether taken continuously or only during the luteal phase1 (see Table 1). This applies to overall symptoms as well as specific ones like psychological, physical, functional symptoms and irritability. The effectiveness of SSRIs was consistent regardless of when they were taken, though continuous use seemed to be more effective for overall symptoms than luteal-phase-only use. Most effects were small to moderate, but all SSRIs tested showed effectiveness.1
| Outcome measured | Success | Evidence | Caveat | |
|---|---|---|---|---|
| Overall self-reported PMS/PMDD symptom score | Using SSRIs resulted in a significant improvement in symptoms reported by women suffering from PMS and PMDD. | This evidence is of moderate quality and is based on 1742 participants from 12 studies. | SSRIs showed a significant increase in overall adverse events comparative to placebo. The most common of these were nausea (NNTH 8), asthenia (NNTH 9), somnolence (NNTH 13), dry mouth (NNTH 15) and sexual dysfunction (NNTH 16). | |
| Effect of SSRI’s when prescribed continuously versus prescribed only during luteal phase | Using SSRIs continuously resulted in a greater improvement in symptoms reported by women suffering from PMS and PMDD comparative to SSRI’s given only in the luteal phase. | This evidence is of moderate quality and is based on 1742 participants from 12 studies. |
However, adverse events were common and should be carefully considered when evaluating the effectiveness of SSRIs. Women with PMDD may benefit the most from this treatment as they may be willing to balance the potential side effects with the relief the treatment provides.1
References
1 Jespersen C, Lauritsen MP, Frokjaer VG, et al. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev [8] 2024; CD001396.
| Crossref | Google Scholar | PubMed |
2 Liu X, Li R, Wang S, et al. Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019. Hum Reprod 2024; 39(6): 1303-1315.
| Crossref | Google Scholar | PubMed |
3 World Health Organization. ICD-11: International classification of diseases (11th revision). 2022. Available at https://icd.who.int/
4 Miller KN, Standeven L, Morrow AL, et al. GABAergic neuroactive steroid response to sertraline in premenstrual dysphoric disorder. Psychoneuroendocrinology 2024; 160: 106684.
| Crossref | Google Scholar | PubMed |
