Changes to the Menstrual Cycle Caused by Psychotropic Drugs
Studies on this subject are sparse, but there are studies which demonstrate that Prozac (SSRI), clomipramine (a tricyclic), venlafaxine (SNRI), escitalopram (SSRI), and bupropion (NDRI are all known to cause changes to a woman’s menstrual cycle.2-4,13,15
Changes that psychotropic drugs can cause to a woman’s menstrual cycle include:
- Skipped periods
- Heavier than usual periods
- Longer periods
- Shorter periods
- Variations in drug concentration can occur before, during and after the menstruation cycle
- Variations in hormone concentration can occur before, during, and after menses
Another area of concern is the drug-drug interactions that can occur when a woman is taking hormonal contraceptives at the same time as antidepressants. While not specifically related to premenstrual disorder, it is a common scenario. And of importance, it should be noted that taking an SSRI while also taking contraceptives can increase or decrease drug concentration, and this may cause safety issues and disturbing fluctuations in symptoms.7
What is “Luteal Phase” Prescribing?
Luteal refers to the 12-14 days before the onset of menstruation. During this time, the body increases its secretion of progesterone. Progesterone is a hormone that prepares the body for potential pregnancy. Conception can occur after the luteal phase.
The practice of prescribing SSRI antidepressants during the luteal phase has become more common. However, it remains controversial for several reasons. First, it is not known exactly how prescribing 2 weeks of an SSRI can affect reproductive issues such as menstruation, fertility, and cardiovascular birth defects.2,4,10,13,14,20,21
And there is an additional concern with luteal prescribing — the problems associated with short-term SSRI withdrawal, particularly because in Luteal phase prescribing, the SSRI is abruptly stopped after the onset of menstruation begins. Abruptly stopping antidepressants is one of the most written about concerns related to the prescribing and deprescribing of antidepressants.22
What is PMS, and Who coined the Term?
PMS means premenstrual syndrome.1,5,6,12,16 In the medical literature, the condition of PMS refers to a set of symptoms that arise in the 12-14 day period before the beginning of the menstruation cycle. 
These symptoms are commonly described as headache, bloating, irritability, fatigue, pain in the breasts, depression and anxiety.
The term was first used in the medical literature in the 1950s. A female doctor named Katherina Dalton in the UK was interested in her and her patients’ premenstrual symptoms (previously called premenstrual tension) and was looking for a solution. She coined the term PMS to describe the cluster of symptoms described above.17
Various hormone treatments were used such as injecting progesterone, or oral synthetic progesterone, and even male hormone estrogen was used. Other methods were dehydration therapy, using diuretics to counteract water retention. Though the study group was small (84 patients) the results of these treatments were lackluster and soon abandoned.
What she did find helpful was vitamin therapy, which is discussed further below. It is perhaps most important to note that the physician who coined the term PMS never encouraged the use of antidepressants to help or treat the condition.
PMDD (premenstrual dysphoria disorder) and the Pharma Industry
PMDD is described as a more intense cluster of PMS symptoms. This term found its way into the DSM in 2013 and was immediately associated with the use of antidepressants to treat it. That is when the pharmaceutical industry became interested in this aspect of women’s health.18
There was considerable controversy at this new juncture in women’s medicine, but the trend has continued to be used in mainstream medicine today. PMDD placed premenstrual symptoms into a category of mental illness, and SSRIs become the “go-to” treatment strategy for it.
Vitamins — Treatment Without Risks to Your Menstrual Cycle
As Dr. Dalton found in her 1950s research, it was vitamin therapy that actually relieved the symptoms of premenstrual discomfort. In particular, she found vitamin B and vitamin A to be effective, especially where patients were found to be deficient in these micronutrients.
Dr. Dalton’s contemporaries were experimenting with other treatments including radiating the ovaries to basically kill them, or removing them altogether with surgery.
Vitamin therapy proved useful, and didn’t harm the patient or the reproductive system.
Other Alternative Treatments for Menstrual Problems
In non-Western countries, and even in America, doctors have found great efficacy with certain plant-based and herbal concoctions that relieved menstrual-related symptoms in their patients. In fact, at least 571 plant-based/herbal treatments have been surveyed and found to be helpful. It is thought that fresh, edibles, and teas made from the live plant leaves can be the most effective ways to use these for providing relief.
8,9 A naturopath or licensed herbalist would be among the best resources for acquiring these treatments along with instructions on how and when to use them safely.
Sample of herbal and plant-based remedies found effective for menstrual difficulties can include:
- Ginger
- Common rue
- Angelica sinensis
- Fennel
- Catharanthus roseus
- Asteraceae
- Lamiaceae
- Apiaceae
- Fabaceae
- Zingiberaceae
ATMC Programs Use Safe, Non-pharmacologic Treatments
Clients coming to ATMC for inpatient treatment are often pleasantly surprised at the wealth of knowledge of our care staff about safe, non-pharmacologic treatments that won’t adversely affect your menstrual cycle. Clients come to us with a wide range of difficulties and conditions that may have been troubling the client for a very long time. We look for root causes, whether that means a nutritional, hormonal, or other kind of overhaul. Lab-testing is an extremely important tool we use in developing each client’s unique program.
Where antidepressant withdrawal is being considered, there are alternative treatments we can provide that may be a better fit for your overall health and mental health goals. If antidepressant medication for PMS or PMDD was unsatisfactory, there are better, safer solutions for you.
We are pleased to share all of this knowledge with our clients so that they can take advantage of non-toxic treatments, nutritional therapy, and comfort therapies that can be life-changing. Many learn new practices that can be taken with them after completing their stay with us. Please contact us directly if you or a loved one is in need of non-pharmacological treatments for chronic conditions like PMS, PMDD, or others, that could be addressed within a holistic, evidence-based, effective program.
