Antidepressant's Effects on the Menstrual Cycle

Antidepressants may interfere with a woman’s menstrual cycle. Some women taking antidepressants may experience side effects and changes in their monthly cycle or menstrual period. Depression is approximately twice as common in women as it is in men in the United States, affecting one in five women. Prescribed antidepressants may help women cope with psychological, emotional and behavioral problems related to reproductive events, such as menstruation, premenopause, perimenopause and menopause.

Ease Premenstrual Conditions

Antidepressant therapy with selective serotonin reuptake inhibitors or SSRIs such as fluoxetine, sertraline and paroxetine may help alleviate premenstrual depression. For some women, taking prescribed antidepressants for only a few days each month may help regulate menstrual cycle-related mood changes. Peter D. Kramer’s 2008 article, “Another Quick Effect of Antidepressants,” describes a 2007 study conducted by Professor Mikael Landén and colleagues at the Karolinska Institute in Stockholm, Sweden, in which women experiencing premenstrual anger and irritability were given either Paxil or a placebo, which they took when they started feeling irritable between ovulation and menstruation 1. Researchers found problems with irritability, depression, mood swings and bloating for women on Paxil were significantly reduced when compared with the women taking the placebo.

The SSRI antidepressant sertraline may also improve psychological and behavioral symptoms in women suffering from premenstrual dysphoric disorder and premenstrual syndrome, according to a 2002 paper presented by Ellen W. Freeman, Ph.D., to the American Psychiatric Association.

Treat Perimenopausal and Menopausal Depression

Depression seems to be influenced by the menstrual cycle, postpartum period and menopause. Many women suffer from mood changes and some experience major depression during perimenopause 3. Results of a Virginia Commonwealth University study released in 2010 showed antidepressants might alleviate symptoms of major depression in perimenopausal or menopausal women. Researchers compared effectiveness and safety of desvenlafaxine, an antidepressant better known as Pristiq, to a placebo. The double-blind study led by professor of psychiatry and obstetrics/gynecology Susan G. Kornstein, M.D., found the way women respond to antidepressants may depend on what stage of life they are in. Her study was the first to test and demonstrate the effectiveness of antidepressant use in depressed perimenopausal and postmenopausal women.

Side Effects

Changes and irregularities in the menstrual cycle have occurred in women taking antidepressants. Fluoxetine, venlafaxine and bupropion have been implicated in menorrhagia—heavy or prolonged menstrual bleeding. Women taking bupropion report experiencing shortened menstrual cycle, menstrual spotting or amenorrhea—absence of menstruation. The precise connection between vaginal bleeding and antidepressants is unknown, but theories suggest fluctuation and modulation of hormones are responsible. Serotonin may affect the menstrual cycle by stimulating secretion of specific hormones, according to a 2002 paper on Venlafaxine-Associated Vaginal Bleeding written by professor Sunny A. Linnebur, Pharm.D., of the University of Colorado School of Pharmacy.

Infrequent, uncommon side effects for sertraline or Zoloft are menstrual disorder; dysmenorrheal or severe uterine pain; intermenstrual bleeding; vaginal hemorrhage; amenorrhea or absence of menstruation; leucorrhea or abnormal vaginal discharge; and rarely, menorrhagia or heavy bleeding.

Reproductive or menstrual-related side effects of escitalopram or Lexapro are infrequent and may include menstrual cramps, menstrual disorder, menorrhagia or heavy bleeding, spotting between periods and pelvic inflammation.