How SSRIs Affect Periods
Medically reviewed by Gurdeep S. Sareen, PharmDMedically reviewed by Gurdeep S. Sareen, PharmD
Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that can affect menstrual (period) bleeding, with side effects such as missed periods or heavy bleeding. Examples of common SSRIs are Celexa (citalopram), Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline).
Scientists are still determining why and how SSRIs affect menstruation, but these drugs appear to have an impact on certain hormones.
In this article, learn more about how SSRIs affect periods and how to manage these changes.
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Related: What Can Affect Your Period
Effect of SSRIs on Periods
SSRIs can affect your period in various ways; they can cause you to miss periods or have heavier bleeding than usual.
One study found that menstrual disorders were more common among people who take antidepressants (24.6%) compared to people who do not take antidepressants (12.2%).
Delayed or Absent Periods
Some people taking SSRIs may experience delayed or absent periods (amenorrhea).
Both Zoloft, whose main ingredient is sertraline, and Lexapro, a brand of escitalopram, have been associated with amenorrhea. However, most of the research on this topic comprises case studies of individuals, so it is hard to draw conclusions and seems to be a rare occurrence.
Researchers theorize that antidepressants are linked to amenorrhea due to the hormone prolactin, which helps regulate the menstrual cycle (among other functions).
SSRIs can cause abnormally high levels of prolactin (hyperprolactinemia) and lead to amenorrhea. However, the link between antidepressants and amenorrhea due to prolactin is weak; more research is needed.
Heavy Bleeding
You can also experience heavier-than-normal periods due to SSRIs.
Multiple case studies have linked Prozac, whose main ingredient is fluoxetine, with heavy menstrual bleeding. In these case reports, new heavy menstrual bleeding occurred while using fluoxetine but subsided when the medication was discontinued.
Intermenstrual Bleeding
There are also some reports of SSRIs and intermenstrual bleeding (metrorrhagia), which is vaginal bleeding that occurs outside the expected period.
One case study of a 34-year-old woman who started Zoloft found that she had sudden, mid-cycle vaginal bleeding on her third day of treatment. Her bleeding stopped within 24 hours of discontinuing Zoloft.
In another case study of a 54-year-old woman who was postmenopausal (had gone through menopause, the time in which menstrual periods have stopped for 12 straight months) and started Lexapro, she experienced heavy vaginal bleeding for a week, which subsided a few days after discontinuing Lexapro.
Types of SSRIs Most Likely to Affect Periods
Antidepressants affecting your period is a relatively uncommon occurrence, although additional large-group studies are needed to fully understand its impact, including the risks associated with each type of SSRI or serotonin-norepinephrine reuptake inhibitor (SNRI).
The most extensive study to date on SSRIs and abnormal bleeding was a 2012 study that examined 1,432 women, with a control group and an antidepressant group.
In that study, menstrual disorders were most associated with the following antidepressants:
Paxil
Effexor XR (venlafaxine)
Zoloft
A combination of the above with Remeron (mirtazapine)
Not everyone who takes SSRIs will experience a change in their periods. In the previous study, the incidence of antidepressant-induced menstrual disorders was 14.5%.
Coming Off SSRIs and Menstruation Effects
If you're experiencing abnormal uterine bleeding, consult with your prescribing healthcare provider. Coming off SSRIs may help resolve heavy bleeding or amenorrhea, as shown in various case studies.
However, suddenly quitting antidepressants can be dangerous. Always do this under the guidance of a healthcare provider who can offer alternative medications and instruction for the safest way to lower or discontinue your dosage.
Seek Help for Depression
If you think you may be in a position to harm yourself or someone else, call 911 or your local emergency number ASAP. There are also several treatment resources and support groups that can be sought through the Substance Abuse and Mental Health Services Administration (SAMHSA) National Hotline at 800-662-HELP (4357).
If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor.
How to Manage SSRI Side Effects
SSRIs have side effects beyond affecting menstrual bleeding. These include:
Anxiety
Blurred vision
Diarrhea or constipation
Dry mouth
Headache
Loss of appetite
Loss of libido
Nausea
Sleep problems
Sweating
Most side effects subside after a few weeks of taking the medication. If you struggle to tolerate side effects, work with your healthcare provider. They may adjust your dosage, the time of day you take your medication, or the medication itself to reduce side effects.
Benefits vs. Drawbacks
When dealing with side effects from SSRIs, it's important to consider the benefits and drawbacks of what led you to take the medication in the first place. Some people take SSRIs to cope with premenstrual dysphoric disorder (PMDD) or other female reproductive conditions such as endometriosis.
Is It My Antidepressant or Something Else?
While it is important to consider the medication you take and its possible side effects, there may be another cause of changes in your periods.
Stress, weight loss, vitamins or supplements, contraceptive pills or devices, and various conditions, such as polycystic ovary syndrome (PCOS, in which ovaries produce an abnormally high amount of androgens) and adenomyosis (tissue normally lining the uterus grows into the muscular wall of the uterus), and more, can all affect your periods.
Antidepressants and PMDD
Premenstrual dysphoric disorder is a mood disorder that occurs during the two weeks leading up to your period, known as the luteal phase of the menstrual cycle. It is more severe than premenstrual syndrome (PMS), and symptoms include depression, mood swings, hopelessness, irritability, anxiety, and more.
Antidepressants are considered a first-line treatment for PMDD and more severe cases of PMS. Unlike treatment for general depression, antidepressants can be prescribed intermittently for PMDD and PMS. This means that you take the medication during the luteal phase but not during other phases, and it can help reduce side effects and withdrawal symptoms.
Summary
Antidepressants have been linked to abnormal uterine bleeding, including missed periods, heavy periods, or bleeding between periods. However, the research on this topic is sparse and primarily limited to case studies. It is, therefore, difficult to conclude how likely an SSRI is to have this side effect or what types of SSRI are more likely than others to have this side effect.
If you are taking an SSRI and experience menstrual abnormalities, be sure to let your healthcare provider know so they can make an appropriate assessment and recommendation.
Read the original article on Verywell Health.
