By Madeline Martins, RHN
I recently visited my medical doctor because I have been experiencing severe PMS symptoms. They include:
- Mood swings
- Feeling bloated
- Brain fog
- Muscle aches & pains
I was hoping my doctor would sign a permission sheet allowing me to work fewer hours per day for the couple of days leading up to my menstrual cycle. She suggested I start taking selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed antidepressant medication. I told her that I had no interest in taking SSRIs for my premenstrual (PMS) symptoms. When she asked why, my automatic response was, “BECAUSE THEY’RE POISON.”
I told her I was more interested in finding the root cause of my PMS and treating the symptoms with lifestyle changes such as more rest. I told her I would prefer to try natural remedies. Her response was, “I can refer you to an OBGYN, but she will most likely say you only have two options: start the birth control pill or start SSRIs.” My doctor then told me that clearly I’m not coping well, and SSRIs are not as bad as I think.
Since I have a very sensitive GI system, I asked my doctor if the cause of my PMS was GI related, since 90% of serotonin in the body is made in the gut. Since she was suggesting a medication that supposedly regulated the uptake of serotonin in the brain, I thought this was a good question. My doctor’s response was, without hesitation, “It’s not related.” She did, though, sign my reduced hours sheet.
OK, hold on, did I overreact?
My immediate reaction to my doctor suggesting that I take SSRIs was that they are poison. Was that an overreaction? I needed to look into why my doctor might be suggesting this treatment.
I work at a university and lucky for me I have full access to medical journals from all over the world, so I started reading. I came across a meta analysis on the use of SSRIs for premenstrual dysphoric disorder (PMDD), which is a severe form of PMS. A meta analysis is when scientists look at a group of studies to examine the outcome of a specific treatment. This meta analysis led by Dr. Nirav Shah was published in the Obstetrics & Gynecology journal in 2008.1 It looked at 29 clinical trials that collectively included 2,964 women. When all of the studies were averaged it showed that the use of SSRIs relieved PMS symptoms by 40%. The symptoms that were reduced were irritability, depressed mood and carbohydrate cravings.
I wanted to know more so I continued reading and came across an article published in Psychosomatic Medicine in 2004 led by Dr. LS Cohen.2 This study looked at SSRIs for PMDD. The study included 313 women who were placed in either a control group (and took a placebo) or a treatment group (and took an SSRI). This study showed more than a 50% improvement in mood symptoms in the treatment group compared to women taking a placebo. This study also showed that at a high dose, SSRIs also helped improve the physical symptoms of PMDD.
What concerned me was the percentage of women who had to drop out of the study due to reactions to the SSRI. (In this case, the SSRI was Paroxetine.) Twenty-three per cent of the women in the treatment group had to stop taking the SSRI due to one or more of the following side effects:
- Low energy/weakness
- Decreased sex drive
- Female genital disorders
- Dry mouth
Are SSRIs not as bad as I think?
The meta analysis and Psychosomatic Medicine study showed that SSRIs can significantly relieve PMS and PMDD symptoms. But unfortunately, many women experience side effects that can be worse than their PMS or PMDD symptoms. I visited drugs.com, a popular drug information website. I wanted to know the reported side effects of Fluoxetine. (I decided to look at Fluoxetine because it was the most commonly studied SSRI in the meta analysis.)
Fluoxetine possible side effects (not a complete list):
Most common side effects include:
- Hives, itching or skin rash
- Inability to sit still
Other possible side effects include:
- Menstrual pain
- Breast soreness
- Increase suicidal ideation
If your doctor said that the drug that he or she is prescribing for your PMS or PMDD symptoms may cause death, would you take the drug? Are you willing to take that risk with your body to treat these symptoms?
It’s OK to say “No” to your doctor
This is a sensitive topic. Doctors are respected professionals, and most doctors only want to help you feel better. They are people too though, and no person is perfect or has all the answers.
Your doctor may not have all of the information and experience necessary to help you with your problem. Most were not taught in medical school that there are lifestyle and natural treatments available for PMS and PMDD. A doctor would only know about lifestyle and natural treatment options if he or she studied them in his or her own time. Most doctors are too busy or feel that it is not important to stay up to date on the latest research in natural medicine. In a 10-minute visit, it is easier for them to write a prescription than to discuss lifestyle changes, treatment options, and the benefits and risks associated with a medication.
We live in an amazing time in which information is available at your fingertips via the Internet. If you don’t know if the treatment your doctor is prescribing is right for you, do your own research. Look at the benefits, the possible side effects and alternative treatment options. You know your body and if a treatment suggestion doesn’t seem right to you or if you need to think about or research the topic, don’t be afraid to tell your doctor “no” or “let me consider it.” It is important that you feel comfortable with the treatment you choose because ultimately you are in charge of your health.
1. Nirav R Shah, MD, MPH et al. Selective Serotonin Reuptake Inhibitors for Premenstral Syndrome and Premenstrual Dysphoric Disorder A Meta-Analysis. Obstetrics & Gynecology, 2008 May, 111(5): 1175-1182.
2. Cohen LS et al. Paroxetine Controlled Release for Premenstrual Dysphoric Disorder: a Double-Blind, Placebo-Controlled Trial. Psychosomatic Medicine, 2004 Sept-Oct; 66(5): 707-13
All information in this article is intended for educational purposes only. It is not intended to substitute for medical advice. For the diagnosis and treatment of any disorder, consult a physician or naturopathic doctor. Consult with your physician or naturopathic doctor about any options or recommendations contained in this article.
Stay tuned for the next article in which we’ll look at natural treatment options for PMS.
Now I’d like to hear from you! Have you tried an SSRI for PMS or PMDD? Have you had success with this treatment? Have you tried any natural treatments for PMS or PMDD? Please leave a comment in the section below.