What is the first-line treatment for severe premenstrual syndrome (PMS) when pregnancy is desired?

• A. Metformin (Glucophage)
• B. Spironolactone (Aldactone)
• C. Fluoxetine hydrochloride (Sarafem)
• D. Ibuprofen (Motrin)

Answer: (C)

Fluoxetine hydrochloride, commonly known as Sarafem, is recognized as the first-line treatment for severe premenstrual syndrome (PMS), especially when pregnancy is desired. This selective serotonin reuptake inhibitor (SSRI) has been shown to alleviate emotional symptoms associated with PMS, such as mood swings, irritability, and anxiety, without adversely affecting fertility or pregnancy outcomes.

SSRIs like fluoxetine can be effective in managing the psychological and emotional aspects of PMS, making it a suitable choice for those desiring pregnancy since they do not compromise reproductive health. The medication can be used in a targeted manner, given at specific times during the menstrual cycle, to provide relief when it is most needed.

In contrast, metformin is primarily used for managing insulin resistance and diabetes rather than directly addressing PMS symptoms. Spironolactone is often utilized for issues related to fluid retention and hormonal imbalances but is not typically the first choice for severe PMS, especially in the context of fertility. Lastly, ibuprofen can help with physical discomfort, such as pain or cramps associated with PMS, but it does not address the psychological symptoms that can be more debilitating for some individuals. Therefore, fluoxetine stands out as the most appropriate choice in this specific scenario